Study shows lung cancer screening feasible in primary care.

Abstract

Findings showed low adverse event rates and 70% of diagnosed lung cancers being detected in early stages. The authors say that the results provide further data for some leaders in the primary care community who have questioned whether evidence from the National Lung Screening Trial was sufficient to support routine screening in the community setting. Results from that trial, published in 2011, led the US Preventive Services Task Force to recommend systematic, lowdose computed tomography lung cancer screening for highrisk individuals. However, the American Academy of Family Physicians said at the time that the evidence was insufficient to make a recommendation for or against the screening and that primary care providers should engage in shared decision making with their patients about whether or not they should be screened. In this study led by John Handy, Jr, MD, of the Providence Cancer Institute in Portland, Oregon, researchers analyzed more than 6000 lung cancer screenings within the community health system. Primary care providers referred the patients, and data were collected prospectively from November 2013 to December 2018 and retrospectively analyzed. Findings showed that lung cancer diagnosis, stage shift, intervention frequency, and adverse event rates were similar to those in the National Lung Screening Trial, and they indicated that lung cancer screenings can be safely and effectively performed in the community setting, the authors say. An ongoing concern is that screenings carry the risk of net harm, including false-positives. In an accompanying editorial response to the study, Chyke Doubeni, MD, MPH, a Mayo Clinic epidemiologist and health services researcher, cautions that the “window of net benefit” relies on a variety of factors involved with both screening and treatment. They include the quality of computed tomography images and interpretation; the prevalence of disease in the population; the health status of patients; and the timeliness, safety, and effectiveness of treatment after abnormal screening results.