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Lung cancer screening does not increase unnecessary surgeries
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Adoption of a lung cancer screening program that used a standard reporting system did not lead to increased rates of surgical interventions for noncancerous disease, according to results of a retrospective analysis.
Earlier this year, CMS agreed to cover annual lung cancer screening with low-dose CT for Medicare beneficiaries aged 55 to 77 years who have a 30 pack-year smoking history and either currently smoke or have quit within the past 15 years.
Prior studies have demonstrated screening can reduce lung cancer mortality by up to 20% in this high-risk population. However, concerns exist that screening may lead to unnecessary surgical procedures performed for benign disease.
Christina Williamson, MD, of the department of cardiovascular and thoracic surgery at Lahey Hospital & Medical Center in Burlington, Massachusetts, and colleagues used a prospectively collected database to review data from 1,654 consecutive patients who underwent lung cancer screening with low-dose CT between January 2012 and June 2014. All individuals met the National Comprehensive Cancer Network’s criteria for being at high risk for lung cancer.
Twenty-five (1.5%) of these patients underwent surgery.
Twenty of those 25 (80%) had lung cancer, and the majority of those diagnosed with lung cancer (n = 18; 90%) had early-stage disease.
Five of the 25 patients who underwent surgery had non-lung cancer diagnoses. They included two necrotizing granulomas, two hamartomas and one breast cancer metastasis.
Researchers determined incidence of surgery for non-lung cancer diagnosis was 0.3%, comparable to the 0.62% rate reported in the National Lung Screening Trial, which served as the foundation for CMS coverage of lung cancer screening in the United States.
Williamson and colleagues determined incidence of surgery for benign disease was 0.24%.
They reported no surgery-related deaths and one incident (4%) of major surgical complication at 30 days.
“Lung cancer screening saves lives, and our study serves as a model for how to set up a screening program that is safe and effective for patients,” Williamson said in a press release. “A screening program should use a standardized reporting system and have input from board-certified cardiothoracic surgeons as part of a multidisciplinary team evaluating CT scan findings. It is only by minimizing the number of operations for benign disease and maintaining a low morbidity and mortality for surgical resection that the full benefit of lung cancer screening can be realized in its widespread adoption in clinical practice.” – by Jeff Craven
Disclosure: The researchers report funding from Covidien and Philips Radiology Medical Advice Network.
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