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Duke University offers strong data-driven release on lung cancer screenings for former smokers

High-risk lung cancer patients may not need annual screenings

Our Review Summary

CT scanThis news release summarizes a study published in Lancet Oncology which looked at the appropriate frequency of screening using low-dose computed tomography (CT) for lung cancer in former smokers. The 7-year study included more than 19,000 individuals with an initial negative CT scan. These patients were much less likely to have lung cancer on future scans compared to those whose initial scans had detected an abnormality. The news release provides good descriptions of the benefits and evidence from the study.

 

Why This Matters

A re-analysis of the world’s largest lung cancer screening trial could have major consequences for patients and health systems. This study found that if initial low-dose CT screening is negative then less frequent subsequent screening seems reasonable. The study also pointed out an important side effect of reduced screening: reduced exposure of patients to radiation and over-diagnosis. In addition, reducing the frequency of screening CT from once a year to even once every two years in a sub group will reduce the costs of screening dramatically.

Criteria

Does the news release adequately discuss the costs of the intervention?

Satisfactory

The release appropriately mentioned that a changed frequency of screening could save millions of dollars in subsequent screenings and “reduced downstream” effects of false positive tests.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

A thorough discussion of the absolute numbers affected gives a good sense of the magnitude of the benefits. The release noted, “In the first year after a negative screen and before the scheduled first annual screen, 17 patients (0.9 percent of all initial negative LDCT participants) were diagnosed with lung cancer.”

Another benefit described is the potential to dramatically reduce the number of false positive tests. According to the release, almost 40 percent of the entire group of patient volunteers (26,231 people) in the 7-year National Lung Screening Trial were given a false positive study result.

Does the news release adequately explain/quantify the harms of the intervention?

Satisfactory

Excessive radiation exposure and risk of false positives were both mentioned.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The news release does a good job describing how the researchers achieved their findings, the demographics of the patients involved, and the absolute numbers for outcomes (the small number of patients who encountered cancer following a clear initial CT scan). The release says that the researchers examined data taken from a large prospective study. It would have been good to spell out for readers that this study was retrospective — a re-analysis of components of a larger randomized controlled trial. The news release does allude to some of the limitations of the research stated in the discussion section of the published results. For example, the release makes note of the high incidence of false positives inherent in screening tests. The published report also states that the study could not clearly discern whether the low incidence of tumors in the group studied was due to early, slow growing tumors (“a direct effect of indolent biological behaviour”) or to volunteers being resistant to tobacco-induced lung injury. The lead study author is quoted in the release saying “improving the accuracy of LDCT screening for lung cancer would also significantly reduce the number of annual screens.”

Taken on the whole, we give the release a Satisfactory for this criteria.

Does the news release commit disease-mongering?

Satisfactory

No disease mongering here. This was a balanced news release.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

No funding or conflicts of interest were mentioned in the news release. While changes in lung cancer screening schedules could have benefits for a wide range of people, we’d still like the release to address the issue of sponsorship. We’re not implying there was a conflict (we don’t know if there were outside funders), but if a manufacturer did sponsor such a study it could pose a potential for conflict of interest that readers should be made aware of.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The release mentions alternatives in two different contexts. Chest radiography was an alternative test to CT scans. The study set out to analyze the most beneficial frequency of screenings and concluded that less frequency is a better alternative for smokers with an initial negative screen.

Does the news release establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The release doesn’t specify where low-dose CT is used and if most readers can access it. We do know that the screen has been approved for use in the United States and is being adopted by some health centers.

Does the news release establish the true novelty of the approach?

Satisfactory

There were no misleading statements of novelty of the CT screening, just novelty of interval which were appropriate.

Total Score: 8 of 10 Satisfactory

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