Abstract
BackgroundPublic health authorities worldwide discourage the use of chest radiography as a screening modality, as the diagnostic performance of chest radiography does not justify its application for screening and may even be harmful, since people with false positive results may experience anxiety and concern. Despite the accumulated evidence, various reports suggest that primary care physicians throughout the world still prescribe chest radiography for screening. We therefore set out to index the use of chest radiography for screening purposes among the healthy adult population and to analyze its relationship with possible trigger factors.MethodsThe study was designed as a cross-sectional survey. Five thousand four hundred and ninety-nine healthy adults, coming from 26 Greek provinces were surveyed for screening practice habits in the nationwide anticancer study. Data were obtained for the use of screening chest radiography. Impact of age, gender, tobacco exposure, family history positive for malignancies and professional-risk for lung diseases was further analyzed.Resultswe found that 20% (n = 1099) of the surveyed individuals underwent chest radiography for screening purposes for at least one time during the previous three years. Among those, 24% do so with a frequency equal or higher than once yearly, and 48% with a frequency equal or higher than every three years. Screening for chest radiography was more commonly adopted among males (OR 1.130, 95% CI 0.988–1.292), pensioners (OR 1.319, CI 1.093–1.593) and individuals with a positive family history for lung cancer (OR 1.251, CI 0.988–1.583). Multivariate analysis confirmed these results.ConclusionDespite formal recommendations, chest radiography for screening purposes was a common practice among the analyzed sample of Greek adults. This practice is of questionable value since the positive predictive value of chest radiography is low. The implementation of even a relatively inexpensive imaging study on a national scale would greatly burden health economics and the workload of radiology departments.
Highlights
Public health authorities worldwide discourage the use of chest radiography as a screening modality, as the diagnostic performance of chest radiography does not justify its application for screening and may even be harmful, since people with false positive results may experience anxiety and concern
Chest radiography has a long tradition in medical care, its prescription for screening purposes among healthy individuals is discouraged by public health authorities [1,2,3,4,5]
Definition Since the diagnostic performance of chest radiography does not justify its application in any screening setting, we considered chest radiography being done for screening purposes in any of the following situations: 1) periodic health examination; 2) check-up visit; 3) chest radiography in asymptomatic individuals due to patients' will; 4) regulatory reasons
Summary
Public health authorities worldwide discourage the use of chest radiography as a screening modality, as the diagnostic performance of chest radiography does not justify its application for screening and may even be harmful, since people with false positive results may experience anxiety and concern. Various reports suggest that primary care physicians throughout the world still prescribe chest radiography for screening. The diagnostic performance of chest radiography does not justify its application for screening neither in the general population nor in "high risk" groups like smokers or people with a family history of lung cancer [6,7]. Despite the accumulated evidence and the clear guidelines, various reports suggest that primary care physicians throughout the world still prescribe chest radiography for screening both in the general population and in selected "high risk" subgroups [8,9,10,11,12,13,14,15,16]. Screening chest radiography may represent a major problem that harms screenees' health, and burdens public-health economics and radiology departments' activities
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