The benefits and harms of lung cancer screening

June 21st, 2019

The Lown Institute and American Family Physician are collaborating on a series of commentary articles called the “Lown Right Care” series. This series applies the framework of right care — evidence-based, patient-focused, high value care — to common clinical situations. Each article provides an example of a common clinical situation where there there are opportunities to avoid overuse by not doing things, and to improve underuse by incorporating things into routine practice.

In the newest edition in the series, Right Care Alliance co-chairs and primary care doctors Dr. Andy Lazris and Dr. Alan Roth discuss the pros and cons of lung cancer screening in primary care, a practice that is promoted by some specialty societies and health providers, but often results in overuse. For patients who are former smokers and know the risks of smoking, it makes sense to ask if they should get screened for lung cancer. Further, the National Lung Screening Trial results of a reported 20% reduction in lung cancer deaths from screening makes this intervention sound very beneficial for patients. 

However, Lazris and Roth point out that the evidence of benefit from lung cancer screening in the community setting is weak. Although a 20% reduction in lung cancer deaths sound impressive, this is a relative, not absolute, reduction. According to the NLST results, about 3 in 1,000 people will be saved from lung cancer over five years. At the same time, 250 of those people will have an abnormal scan result and will have to undergo further testing, which can be stressful and costly. While a CT generally costs about $300, follow-up procedures such as lung biopsies, PET scans, and lung surgeries can cost thousands of dollars. 

For more on the costs and benefits of lung cancer screening, read the AFP commentary, and check out the debate on Twitter!


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