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False-positive lung cancer screening results did not affect anxiety, quality of life
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Individuals who received false-positive or abnormal lung cancer screening results demonstrated no significant difference in anxiety or quality of life compared with those whose screens were negative, according to study results.
Results of the National Lung Screening Trial (NLST) showed annual screening with low-dose CT scans reduced the risk for lung cancer mortality by 20% (95% CI, 6.8-26.7). However, 96.4% of positive results during the NLST eventually were classified as false positives.
Ilana F. Gareen, PhD, assistant professor of epidemiology at Brown University School of Public Health, and colleagues evaluated data from 2,812 NLST participants who completed baseline assessments for health-related quality of life (QOL). Of these participants, 1,947 underwent screening with annual low-dose CT scans, and 865 underwent screening with chest X-ray.
Nearly half of these participants (n=1,381; 49.1%) had negative screening results. Of the remaining participants, 1,024 (36.4%) received false-positive results, 344 (12.2%) had significant incidental findings and 63 (2.2%) received true-positive results.
Participants completed Short Form-36 — which assess health-related QOL with physical and mental component scores — and State Trait Anxiety Inventory questionnaires 1 month and 6 months after screening.
Participants with true-positive results experienced significantly worse physical QOL at 6 months and mental QOL at 1 month and 6 months compared with participants who received normal results (P˂.001 for all). Those who received true-positive results also had significantly higher anxiety scores at 1 month (P˂.01) and 6 months (P˂.05) than those who received normal results.
However, researchers observed no statistically significant difference in anxiety and QOL score changes between participants with false-positive results or significant incidental findings and those who received normal results.
“These results provide evidence that, in a screening program that includes counseling and advises participants of the high likelihood of a false-positive screen and additional testing, there may be no impact on health-related QOL or anxiety for participants who are free of lung cancer,” Gareen and colleagues concluded.
Although these results may reduce concern about anxiety and decreased QOL associated with false-positive results, lung cancer screening programs must continue to ensure those who undergo screening are informed about these risks, Jamie S. Ostroff, PhD, chief of the Behavioral Sciences Service and director of the tobacco treatment program at Memorial Sloan Kettering Cancer Center, wrote in an invited commentary.
“Screening programs need to be aware of the potential for increased short-term, lung cancer-specific anxiety and worry and provide timely disclosure of results, and education and support, as needed,” Ostroff wrote. “Future research is needed to identify effective ways of communicating low-dose CT scan results so as to optimize comprehension, motivate health behavior change (quitting smoking), promote adherence to repeat screening and minimize transient anxiety.”
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Disclosure: The researchers report grant funding from the NCI, as well as consultant and board roles with Endocyte Inc., Frontier Science, Wilex AG and WorldCare Clinical LLC. Ostroff reports no relevant financial disclosures.
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William C. Black, MD
The study by Gareen et al — which showed no significant decrease in health-related quality of life or increase in anxiety among participants who received a false-positive or significant incidental finding screening result — is highly encouraging. However, the authors attribute this surprising finding to the “extensive counseling” that participants received in the National Lung Screening Trial. Although the US Preventive Services Task Force and other medical organizations also recommend counseling, it is not clear who would provide this service and how its cost would be covered outside the setting of a randomized trial.
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