Many smokers with elevated cancer risk don’t adhere to follow-up imaging recommendations

Just over half of current smokers who receive an abnormal chest CT exam adhere to radiologists’ recommendations for follow-up imaging within 30 days, according to results of a study published online Feb. 28 in the Journal of the American College of Radiology.

As the leading cause of cancer mortality in the U.S., lung cancer accounted for nearly 160,000 deaths in 2015. The biggest problem facing doctors and patients, said lead author Sanja Percac-Lima, MD, of Massachussetts General Hospital, and colleagues, is that early detection of the disease has proved problematic.

“The goal of being able to identify lung cancer at an early, potentially curable, stage has long been sought, but has only recently proven successful using low-dose CT,” they wrote. “The widespread implementation of lung cancer screening with [low-dose CT] imaging will require interval follow-up studies and adherence with continued annual screening studies.”

Percac-Lima and his team set out to evaluate the timeliness of follow-up care for smokers at high risk of developing lung cancer after abnormalities were identified in CT examinations. To do so, they used medical charts to obtain radiologist recommendations for follow-up care for current smokers between the ages of 55 and 79 from an academic primary care network who had received a chest CT during 2012. They then determined what proportion of those patients received follow-up care within 30 days while assessing what factors influenced likelihood follow-up of compliance.

Their results showed that of the 376 patients who fell within the study parameters, 337 (90 percent) had abnormal findings, with 184 (55 percent) receiving specific follow-up recommendations. Timely follow-up was conducted in only 102 (55 percent) cases. Twenty-seven patients were diagnosed with lung cancer, with 18 (67 percent) attending their their first oncology visit within 30 days.

“Among patients undergoing diagnostic chest CTs, most received follow-up for abnormal findings, but it was often delayed,” the authors concluded. “Systems to support patients in obtaining recommended follow-up are needed to ensure that the benefits of lung cancer screening translate into usual clinical practice.”