Under medical guidelines first introduced in 2012, physicians are supposed to discuss lung cancer screening in long-term smokers and ex-smokers. Unfortunately, less than 10% of doctors talk about screening with long-term smokers today. The low rate of patient-reported physician patient discussions is caused by negative attitudes among physicians about lung cancer screening and misunderstanding the information about its benefits for individual smokers.
Studies have shown that physicians are reluctant to promote lung cancer screening because of concerns over radiation exposure, false-positive rates, as well as the potential for invasive biopsies, surgical complications and increased health care costs that may result following a screening that tests positive. Because most patients fail to follow smoking cessation counseling, a negative “why-bother” attitude in physicians about smoking cessation carries over to counseling for lung cancer screening in smokers. Physicians have been advised by CMS (The Centers for Medicare & Medicaid Services) to use shared decision making when talking with patients about lung cancer screening. Shared decision making requires a discussion of the risks of screening and follow-up testing versus the benefits of early detection. Unfortunately, doctors are very good at describing the risks; the benefits are not as clearly-described, in large part because of confusion within the medical community.
There are two articles that support the use of lung cancer screening: A New England Journal of Medicine(NJEM) article in 2006 reported that, on an individual basis, 85% of patients diagnosed with lung cancer screening have Stage 1 disease with an 88% five-year survival; another NEJM article in August 2011 reported that, on a population basis, low-dose CT scanning reduces lung cancer mortality by 20%.
Consider this: When doctors counsel patients on benefits vs. risks, telling patients that 85% of smokers with lung cancer can be cured with screening is very different than saying that screening reduces a smoker’s chance of death by 20%.
A willingness to undergo the risks of screening depends on whether there is an 8 out of 10 chance of living as opposed to 8 out of 10 chance of dying anyway. Doctors are reluctant to counsel smokers to start with and by focusing on the arguably-small reduction in population mortality, they rarely give a patient a true understanding of the survival benefit screening has for the individual. It is time for physicians to recognize that smoking is an addiction and that lung cancer screening in long-term smokers is an effective way to prevent death from lung cancer.
Grannis FW. Is shared decision-making CT lung screening’s Tojan Horse?. AuntMinnie.com, (May 9, 2019) ( https://www.auntminnie.com/index.aspx?sec=sup&sub=cto&pag=dis&ItemID=125402 )
Larkin M. Rates of lung cancer screening discussions are low, and falling further. Medscape (May 3, 2019)