Many doctors order inappropriate lung cancer screening

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A paper in the Annals of Family Medicine, “Lung Cancer Screening Practices of Primary Care Physicians: Results From a National Survey,” reports that:

Primary care physicians in the United States frequently order lung cancer screening tests for asymptomatic patients, even though expert groups do not recommend it. Primary care physicians and patients need more information about lung cancer screening’s evidence base, guidelines, potential harms, and costs to avert inappropriate ordering.

One-quarter of primary care physicians believed that 1 or more national expert groups recommend screening asymptomatic patients for lung cancer.

A HealthDay story on the paper (one of the few mainstream news organization stories we found on it) reported:

“There is no authoritative group that is recommending lung cancer screening for asymptomatic individuals,” said study author Carrie Klabunde, an epidemiologist from the applied research program within the division of cancer control and population sciences at the U.S. National Cancer Institute.

“And guidelines are developed by expert groups that generally have a very thoughtful process for evaluating scientific evidence and for coming to a consensus,” she added. “So, it’s important to be aware of what the guidelines for lung cancer screening are. Because in this case, the available screening technology really hasn’t shown a strong benefit, and when used improperly can lead to what may end up being a medical misadventure.”

Apart from wasting medical resources, unnecessary screening can do more harm than good, experts say. False test results can cause undue patient stress and false positives can raise the risk for patient harm resulting from unneeded and invasive treatment.

As a result, experts do not currently recommend a lung cancer screening for a patient who does not show signs of disease, even if that patient has a history of heavy smoking.

Dr. Otis Webb Brawley, chief medical officer and executive vice president of the American Cancer Society, said that it’s important to understand that screening can be a “double-edged sword.”

“I am constantly concerned when we promote the benefit of screenings, and don’t worry about the fact there might be associated harm,” he said.

“I would say, however, that most of the doctors in this survey have been practicing for 25 or 30 years,” Brawley noted. “And because we are starting to teach about screening in school now I am somewhat hopeful that the word will get out among younger physicians. But I would also say that the only way we’re really going to get doctors better on this question is actually by encouraging patients to turn to the large major established organizations like us and the NCI – and get more educated about the facts.”

Couple this paper with the Annals of Internal Medicine paper from last week that showed many doctors don’t understand cancer screening statistics and you get a greater appreciation of how massive is the task of improving the public dialogue about screening tests – when many physicians themselves don’t understand the statistics and don’t know what guidelines do or don’t say.


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