Tag: CT lung cancer screening

How to Improve CT Lung Screening Outcomes

Posted on by Brian Casey

Getting patients to attend cancer screening exams is one of the biggest challenges in healthcare. But a new study in JAMA Network Open should provide motivation, showing that people who showed up for annual CT lung cancer screening exams had better clinical outcomes than those who didn’t. 

Low cancer screening adherence frustrates clinicians and healthcare policy experts alike, but nowhere is the situation as dire as in CT lung cancer screening.

  • U.S. lung screening adherence rates languished in the single digits for years after the exam was approved by the USPSTF, and while there has been some recent improvement, screening rates are nowhere near those of more established exams like mammography. 

At the same time, statistical modeling studies (and common sense) suggest that complying with screening would reduce lung cancer mortality. 

  • So researchers from multiple institutions in the U.S. and Canada decided to track adherence to a real-world CT lung screening program consisting of a baseline scan and then two follow-up scans roughly a year apart. 

In all, 10.2k eligible adults were screened from 2015 to 2018, with researchers finding …

  • Screening adherence rates fell from the first follow-up round to the second (61% to 51%).
  • People who attended the first follow-up round were more likely to attend the second (67% vs. 25%). 
  • Patients who completed both screening rounds had higher lung cancer diagnosis rates (1% vs. 0.2%).
  • Patients who attended the second round and got a lung cancer diagnosis were more likely to have early-stage disease (73% vs. 25%) and less likely to have late-stage disease (21% vs. 58%). 

In analyzing the results, researchers said the drop-off in adherence rates between the first and second follow-up screening rounds represented an opportunity to reach out to people who missed the first round and get them to the second.

  • This position dovetails with other recent research underscoring the importance of patient navigators in guiding eligible people to lung cancer screening. 

The Takeaway

So as radiology and other disciplines look to build on the momentum behind CT lung cancer screening, what’s the key to success in improving patient outcomes? Sometimes, it’s just getting people to show up. 

Are CT Lung Screening Patients Sicker?

Posted on by Brian Casey

Amid the rush of enthusiasm for CT lung cancer screening, a new study published in JAMA Health Forum offers a cautionary note. Researchers found that in the real world, people eligible for lung screening were sicker than those in research studies, and thus may not enjoy screening’s benefits to the same extent. 

Support for CT lung cancer screening is based on randomized controlled trials published in 2011 (NLST) and NELSON (2020) that showed screening reduced lung cancer mortality among high-risk individuals who typically had long smoking histories. 

  • The studies have spurred momentum for large-scale CT lung cancer screening programs, with a number of European and Asian countries starting national initiatives. 

But how generalizable are these results? Researchers noted that people who participated in the NLST study tended to be younger and healthier than individuals who qualify for screening in the real world. 

  • Co-morbidities like COPD, diabetes, and heart disease, as well as age and racial background, can have an impact on survival after treatment for lung cancer, and thus could reduce screening’s risk/benefit calculation. 

In the new Personalized Lung Cancer Screening study, researchers analyzed the comorbidity profiles of 31.8k people who got screened between 2016 and 2021 in California, Florida, and South Carolina. 

  • They noted that their PLuS study cohort was more diverse in terms of age, race, and ethnicity than that used in NLST, and potentially had more comorbid conditions. 

In analyzing their population, PLuS researchers found that compared to NLST participants, people screened in their real-world programs had …

  • Higher rates of COPD (33% vs. 18%).
  • Higher rates of diabetes (25% vs. 9.7%).
  • Higher rates of heart disease (16% vs. 13%).
  • Were more likely to be aged 70 and over (25% vs. 8.8%).
  • Had high scores on various metrics of comorbidity and frailty. 

Older, sicker patients are less likely to have good health outcomes after lung cancer surgery, and might also succumb to conditions like COPD, diabetes, and heart disease before lung cancer, which could also reduce lung screening’s benefits.

The Takeaway

While the new findings aren’t likely to seriously dampen CT lung cancer screening’s growing momentum, they do illustrate a point that should always be kept in mind when looking at research results: in the real world, your mileage may vary. 

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