Smokers dismiss medical advice
People in the high-risk group need to better understand the benefits of screening, said Christine D. Berg, MD, an NLST researcher from the National Cancer Institute.
“We know the uptake of lung cancer screening has been slow,” she said.
She described encouraging her neighbor, a heavy smoker, to get screened. “But she said she didn’t want to know if she had lung cancer, so she didn’t go.”
“Now she’s dead,” Dr. Berg continued. Unfortunately, “what we see is that those who continue to smoke, and smoke heavily, are not likely to heed medical advice.”
The fear of finding out you have lung cancer needs to be overcome, she said. Smokers need to understand that they can add a decade to their lives if lung cancer is detected early.
Some places in the United States have better screening rates than others. “We see a lot of variation from state to state,” she said. For instance, in Massachusetts, 12.3% of high-risk people have been screened; in Nevada, the rate is just 0.5%.
There are many reasons for that. First, there are logistics. Screening covered by Medicare must be done in a certified center “with good equipment and that can track results,” Dr. Berg said. That might be one hurdle. But the greater hurdle is the patients themselves.
There are studies that point to risks associated with invasive procedures, such as biopsy after screening, which can lead to complications, even when no cancer is found. “My answer to that is, if you need a biopsy, check the data. The Society of Thoracic Surgeons has a database of all the complications, and it’s publicly accessible. You can find hospitals in your region that report data,” she explained, and “that have highest volume and lowest complication rates.”
Second, imaging has improved since the NLST trial. “We have a better ability to estimate cancer in the nodules we find,” Dr. Berg explained. Nodules that previously needed a biopsy to confirm malignancy can now be assessed with AI and machine learning.
“I think the probability of false positives and problems from biopsy have changed dramatically over the last 10 years,” she said.
And we are catching more lung cancer earlier and saving lives. Overall, early detection is increasing, and late-stage detection is decreasing. “We’re bending the curve, making progress,” she said.
In 2019, the 5-year survival rate for lung cancer was 21.7%, up from 17.2% a decade earlier, according to the ALA. Much of that is because of early diagnosis, when the disease is still curable, which could be related to increased screening.
“NELSON showed benefit to CT screening and is useful in helping convince some of the skeptics,” Dr. Berg said.
Diagnosis is also improving with new technologies. Electronic health records can be scanned to identify patients at increased risk, and patient portals can send reminders, notifications, and other educational information to encourage patients to discuss options with their doctor, which could improve the national lung cancer prognosis, Dr. Gould said.
At the end of the day, it still comes down to the patient and doctor having a conversation about the risks and benefits.
“But we have to get to that point,” Dr. Gould said. “We need to continue to develop tools to facilitate that conversation. It’s complicated, and there’s a lot of information to weigh.”
“We’re still working out how to do that,” he added.
Dr. Barry, Dr. Gould, and Dr. Berg have disclosed no relevant financial relationships.
This article first appeared on Medscape.com.