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Lung cancer screenings not used to fullest potential

The number of adults screened via the wrong clinical pathway for lung cancer “greatly exceeded” those screened via U.S. Preventive Services Task Force recommendations for the same condition, according to findings recently published in the American Journal of Preventive Medicine.

A second study, appearing in Nicotine & Tobacco Research, found clinicians did not always promote smoking cessation during the lung cancer screening process.

Inconsistent compliance with USPSTF recommendations

In the first study, Thomas B. Richards, MD, medical officer at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, and colleagues noted that in December 2013, the USPSTF recommended annual screening for lung cancer with low-dose chest CT.

Researchers used data from the2010 and 2015 National Health Interview Surveys to determine the prevalence of lung cancer screening that meets USPSTF guidelines. An estimated 8,098,000 people met USPSTF criteria for screening in 2015.

Richards and colleagues found that among those patients, 4.4% (95% CI; 3-6.6) reported undergoing lung cancer screening with a chest CT and 8.5% (95% CI; 6.5-11.1), reported receiving a chest X-ray. In patients who did not meet USPSTF criteria, 2.3% (95% CI; 2-2.6) reported having a chest X-ray and 1.3% (95% CI; 1.1-1.5) reported undergoing a chest CT.

“To realize the potential benefits of lung cancer screening, better processes to appropriately triage eligible individuals to screening, plus screening with a USPSTF-recommended test, would be beneficial,” Richards and colleagues concluded.

Missed opportunity to promote smoking cessation

In the second study, Hasmeena Kathuria, MD, of The Pulmonary Center at the Boston University School of Medicine noted that “lung cancer screening highlights the harms of smoking to heavily addicted smokers.”

Researchers analyzed discussions among 21 physicians and 28 smokers.

They found that physicians using lung cancer screening as a “teachable moment” to encourage smoking cessation sometimes encountered barriers and thus cessation conversations were not universally followed or seen as effective.

Physicians in the study offered several potential strategies for removing the barriers: entrenching dedicated tobacco treatment personnel in clinic to allow for a “warm handoff” of the patient immediately following a lung cancer screening discussion; building on the fear of lung cancer with messages such as “after that scare, this is a good time to quit;” and using negative lung cancer screening results to drive the danger home with messages such as “If you continue to smoke there’s still chance of you developing cancer.” or “Cancer is not the only bad side of smoking.” - by Janel Miller

Disclosures: Kathuria reports consulting for Remedy Partners on relevance of codes for pulmonary services. Please see the studies for all other authors’ relevant financial disclosures.