Using low-dose CT for lung cancer screening has been recommended as the standard of care since the National Lung Screening Trial (NLST) showed a 20% reduction in lung cancer mortality in 2011, according to John R. Handy Jr., MD, director of the Providence Thoracic Surgery Program at the Providence Cancer Institute in Portland, Oregon, and colleagues.
The generalizability of the National Lung Screening Trial to community health settings was confirmed in a recent analysis, researchers wrote in Annals of Family Medicine.
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The NLST authors conceded that one of the trial’s weaknesses was the “recognized expertise of the participating medical centers ‘in radiology and in the diagnosis and treatment of cancer,’ which raised the question of the generalizability of their results to community facilities,” Handy and colleague wrote. This was one of the reasons the American Academy of Family Physicians did not endorse lung cancer screenings, they said.
Handy and colleagues assessed outcomes of a lung cancer screening program in the Portland, Oregon, region of the Providence St. Joseph Health system, which included two non-university tertiary care hospitals, five community hospitals and three free-standing imaging centers.
In the program, a primary care physician has a discussion about cancer risk with the patient, along with shared decision-making focused on smoking cessation and the risks vs. benefits of cancer screening. If the patient decides to continue with lung cancer screening, the following steps occur:
Diagnostic imaging staff conducts a chest CT scan (0.8 m5v to 1.5 m5v).
Thoracic radiologist reviews scans and reports findings to the PCP and patient.
A multidisciplinary group of experts reviews the "highly suspicious" scans.
The patient meets with thoracic specialists if lung cancer is suspected.
Thoracic specialists and the PCP schedule follow-up scans for the patient if they are needed.
The PCP maintains primary responsibility for the patient.
According to Handy and colleagues, the study consisted of 3.402 individuals that generated 6,161 scans. From those totals, there were 500 individuals that underwent lung cancer screening-generated interventions. There were 226 invasive interventions, including 141 diagnostic procedures and 85 surgeries in 176 patients (procedure rate, 6.6%). According to the researchers, 95 lung cancers diagnoses were made over the course of the study, including 60 non-small cell lung cancer (NSCLC) stage I, seven NSCLC stage II; nine NSCLC stage III, eight NSCLC stage IV, and 11 limited or extensive small cell lung cancers. Among the 226 invasive interventions, there were 23 adverse events in 21 patients (10.6%), with pneumothorax being the most common. In the 85 surgeries conducted in the cohort, two patients died (2.3%).
Handy told Primary Care that the results were comparable to the NLST, “predicated upon well-organized multidisciplinary management of eligibility, screening technical aspects and safest and most effective potential interventions.”
Editor's Note: This story has been updated to provide the correct number of individuals in the study.
