Lung Cancer Screening!

Your patient is a 65yo man with a 40-pack-year smoking history. He currently smokes but has cut back to 1-2 cigarettes per day. Should he be screened for lung cancer?


WHY IS THIS IMPORTANT?

 


KEY STUDIES!

A 2011 NEJM study by the National Lung Screening Trial Research Team found a significant reduction in mortality associated with CT screening. 

    • N = 53,454, ages 55-74yo with smoking history
    • 20.0% mortality reduction from lung cancer with 3 LDCT screens
    • 6.7% mortality reduction from all causes
    • 26.3% of people had positive screen, BUT… 96.4% of positive screens were not lung cancer
    • Number needed to screen = 320

But what if our patient is a veteran? A 2018 JAMA study on VA patients found that the number needed to screen was 687-6903 and the false positive rate was 58.2%!


WHO SHOULD WE SCREEN?

 


BENEFITS vs RISKS!

 


HOW TO TIP THE SCALES?


TAKE-HOME POINTS!

  • Smoking cessation = #1 best way to prevent lung cancer, should be forefront of every conversation about lung cancer screening
  • Serial low-dose CT screenings, among certain high risk groups, reduces mortality, though there are significant potential harms
  • Different organizations have slightly different guidelines: ultimately, shared decision making is crucial to decide who to screen
  • Use a decision aid with patients who meet CMS criteria AND who could tolerate screening/procedures

*Blog post based on Med-Peds Forum talk by Cam Ulmer, PGY1