Lung Cancer Screening Not for Everyone

Lung cancer screening may pose more risks than benefits to some patients

(RxWiki News) On the surface, lung cancer screening sounds like a great idea for everybody — but it's not likely that simple.

A discussion with a doctor is the first step of lung cancer screening. Doctors can outline individual cancer risk and the potential benefits of lung cancer screening. A recent editorial explained why not all patients should proceed with screening.

Tanner Caverly, MD, of the Veterans Affairs Center for Clinical Management Research in Ann Arbor, MI, wrote in this editorial, "The goal of screening for lung cancer is to diagnose cancer in the early stages when it is potentially curable. But to achieve cure, a person must be able to tolerate and survive the necessary diagnostic and treatment procedures."

Nathan Pennell, MD, PhD, a medical oncologist with Cleveland Clinic, told dailyRx News that lung cancer is curable.

"Lung cancer is curable when it is in its early stages, but up to now a minority of patients are diagnosed at a curable stage because you can’t see or feel your lungs," Dr. Pennell said. "This is the reasoning behind screening with low dose CT scans, proven to detect lots of curable lung cancers and even reduce the chance of death from lung cancer by 20%."

Dr. Pennell added, "Most nodules found by CT screening will not be lung cancer, and investigating which nodules are cancer has risks, ranging from anxiety between follow-up scans, to direct risk of harm from collapsed lungs after biopsies or surgical complications for nodules that aren’t even cancerous. It is critically important that screening not be extended to people with even lower risk than those in the trial, such as younger patients and lighter smokers that would have a much lower risk of lung cancer and much higher risk that any abnormality would be benign."

Screening for lung cancer is done through low-dose computed tomography (LDCT), which is a type of chest scan. Currently, patients must meet certain criteria in order for the Center for Medicare and Medicaid Services to cover the procedure.

"Those who have smoked for more than 30 pack-years, continue to smoke, or quit within the past 15 years and are 55 to 77 years old will be eligible for free annual LDCT screening," Dr. Caverly wrote.

A pack-year is a measure of a patient's smoking history. One pack-year is the equivalent of smoking one pack of cigarettes each day for one year.

However, Dr. Caverly warned that not all of these patients should proceed with screening. Only patients who would greatly benefit from screening should actually undergo testing, Dr. Caverly said.

In particular, he pointed out three groups of patients who likely should not proceed with lung cancer screening.

  • Patients who have health conditions like heart failure or severe chronic obstructive pulmonary disease would be unlikely to benefit from screening. Dr. Caverly pointed out that they would be unable to tolerate the surgical treatment if lung cancer were to be diagnosed.
  • Patients with other severe health conditions are also likely not good screening candidates for similar reasons, Dr. Caverly wrote. If they are likely to succumb to another disease, then identifying lung cancer should not be a major concern.
  • Finally, patients with a low risk of lung cancer should not be screened due to risks tied to the screening and follow-up tests. Dr. Caverly wrote, "On average, for every 10 lung cancer deaths avoided with screening in the National Lung Cancer Screening Trial, there were 3 deaths due to invasive follow-up testing and surgical treatment of lung cancer."

Dr. Pennell echoed the editorial's points.

"... is your risk of getting cancer high enough that a positive result would likely indicate cancer?" Dr. Pennell said. "Are you likely to live long enough to benefit from treatment of a cancer that might not take your life for a number of years? If those answers are no then you probably shouldn’t be screened."

The bottom line is that screening is a good idea for many, but it is not for everyone. Patients should speak with their doctors about their individual risk for lung cancer and whether screening is a good choice, Dr. Caverly said.

This editorial was published online April 6 in JAMA Internal Medicine.

Dr. Caverly disclosed no funding sources or conflicts of interest.

Review Date: 
April 5, 2015