Evidence study examines both benefits and harms for lung cancer screening

CHAPEL HILL, NC – A comprehensive review by North Carolina University researchers and colleagues of hundreds of publications, including more than two dozen articles on preventive screening for lung cancer by low-dose computed tomography (LDCT) ), showing both the benefits and harms of screening. The review is published in JAMA on March 9, 2021.

The results of the Decadelong National Lung Screening Test (NLST) showed that LDCT could detect lung cancer better than conventional X-rays in normal or previous heavy smokers. Based on these findings, the U.S. Consecration Services Action Group (USPSTF) recommended low-dose CT screening for people ages 55 to 80 with a 30-year packaged smoking history. Subsequently, the results of another screening test were published, including a European test called NELSON, the next largest study to the NLST. NELSON also found a reduction in lung cancer deaths due to screening.

It is almost ten years since the first recommendations were formulated, so the USPSTF began an updated review of the evidence. UNC scientists and their colleagues evaluated and synthesized data from the seven trials to conduct a comprehensive comprehensive assessment of injury and screening benefits.

New proposals, based on this evidence-based study, extend the criteria for screening eligibility by lowering the screening age from 55 to 50 and reducing the package year requirement from 30 to 20 package years. There were several reasons for this change in eligibility according to the reviewers; one was to promote health equity, in part because African Americans have a higher risk of lung cancer even with lower levels of smoking.

“Two major studies have now shown that screening can reduce the chance of dying from lung cancer in high-risk people. However, people considering screening should know that the number is relatively low. few people who are screened benefit, and that screening can also lead to real harm, “said Daniel Reuland, MD, MPH, one of the review ‘s authors, a member of the UNC Lineberger Comprehensive Cancer Center, and senior professor in the department of General Medicine and Clinical Epidemiology at the UNC School of Medicine.

In screening with CT scans, doctors look for lung spots or nodules that may represent early lung cancer. Screening damage can stem from the fact that most nodules found on screening are not cancer. These findings are called false positives, and patients with these results usually need additional scans to see if the spots grow over time. In some cases, these wrong things lead to unnecessary surgery and procedures. Throughout the process, patients may experience the mental distress of a possible cancer diagnosis.

“Applying screening tests to a population without symptoms of disease can certainly be beneficial for some people but it also has the potential to do some harm,” said lead author Daniel Jonas, MD, MPH, who part of this research while he was a professor at the UNC School of Medicine and is now the director of the department of internal general medicine at Ohio State University. ”Regarding lung cancer screening, we are more certain that -now that some people will benefit, with some lung cancer deaths prevented, and we also know that others will be harmed. The USPSTF has measured the overall benefits and harms, and on balance, based on our review and from modeling studies, has shown that LDCT screening has an overall net benefit for high-risk people aged 50 to 80. “

Reuland and Jonas note, confidently, that lung cancer rates are declining, reflecting changing smoking patterns in recent decades. Therefore, the population eligible for screening is expected to decline. At this stage, however, they do not see these trends changing screening proposals in the next decade.

“Different tests have used different screening methods, and we still don’t know how often screening should be done or what procedure for classifying wounds is best for reducing damage, costs and screening burdens while and retain the benefits, “said Reuland, who is also a researcher at UNC ‘s Cecil G. Sheps Center for Health Services Research. “I would prioritize this as an important area of ​​future scrutiny, as it could be addressed by implementing less costly inspections or using methods other than those. used in the large trials we reviewed. “

###

In addition to Reuland and Jonas, the other authors are Shivani M. Reddy, MD, MSc, RTI International-UNC Evidence-Based Practice Center; Max Nagle, MD, MPH, University of Michigan; Stephen D. Clark, MD, MPH, Commonwealth University of Virginia; Chineme Enyioha, MD, MPH, UNC School of Medicine; Teri L. Malo, PhD, MPH, and Alison T. Brenner, PhD, MPH, UNC Lineberger; Rachel Palmieri Weber, PhD, Charli Armstrong, BA, Manny Coker-Schwimmer, MPH, Jennifer Cook Middleton, PhD, and Christiane Voisin, MSLS, RTI International-UNC Evidence-Based Practice Center and Cecil G. Sheps UNC Center for Health Services Research ;; Russell P. Harris, MD, MPH, UNC School of Medicine and Cecil G. Sheps UNC Center for Health Services Research.