Computer tomography (CT) lung screening benefits far outweigh patient anxiety

Anxiety regarding inconclusive cancer screening test results among some patients is real and is only natural. However, as evidenced by a recent study in Cancer (2014; doi:10.1002/cncr.28833), the incidence and effects of anxiety associated with false positive or other results of computed tomography (CT) lung cancer screening exams are far less than claimed by some in the medical community.

“Unsubstantiated claims of systemic and harmful patient anxiety should now be put to rest and not continue to delay implementation of CT lung cancer screening programs or Medicare coverage for these tests. It is clear that the lifesaving benefit of these exams in high-risk patients far outweighs any downside,” said Ella A. Kazerooni, MD, chair of the American College of Radiology Lung Screening Committee.

Gareen and her colleagues found that patients who had an abnormal finding on a lung cancer screening test did not experience more anxiety or reduced quality of life than those who were screened and found to be cancer-free. Imaging experts (researchers and clinicians) and allied professionals continue to work to reduce the number of false-positive test results that patients experience and ensure that follow-up examinations are as minimally invasive as possible. Physicians also continue to refine the reporting process to ensure that patients receive results as quickly as possible.

The primary National Lung Screening Trial (NLST) results, published 3 years ago in the New England Journal of Medicine (2011; 365:395-409), showed that screening high-risk patients for lung cancer using low-dose CT scans significantly reduced lung cancer deaths. The test is at least as cost-effective as other major cancer screening programs and even automobile seatbelts and airbags.

In December 2013, the United States Preventive Services Task Force (USPSTF) recommended annual CT lung cancer screening for high-risk patients. Under the Affordable Care Act, private insurers are required to begin covering this service starting January 1, 2015. However, Medicare is not required to follow USPSTF recommendations. CMS will make its final coverage decision in February 2015.

Significant lung cancer screening infrastructure continues to grow. The American College of Radiology created the ACR Lung Cancer Screening Center program to help certify that these lifesaving examinations are provided in a safe, effective manner. The ACR also launched the first edition of Lung-RADS, a quality assurance tool designed to standardize lung cancer screening CT reporting and management recommendations, reduce confusion in lung cancer screening CT interpretations, and facilitate outcome monitoring.

“For the first time, we can save thousands of people each year from the nation's leading cancer killer. Medicare coverage of these lifesaving exams would provide seniors with ready access to this care and help the medical community save lives,” said Kazerooni.

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