Silence kills: Physician-patient discussion rates about lung cancer screening ‘surprising’

Lung cancer remains the top cause of cancer-related deaths in the U.S., but a new study suggests physicians and patients are discussing screening for the disease less frequently than in the past.

There have been multiple undertakings that support lung cancer screening, perhaps most notably the 2011 National Lung Screening Trial that demonstrated low-dose CT scans reduced lung cancer mortality by 20%.

A study published in January also found a free lung cancer screening program using National Comprehensive Cancer Network guidelines detected more cancers and generated profit for the institution that provided screenings.

However, the April 25 study published in Cancer Epidemiology, Biomarkers & Prevention found patient-physician discussions about lung cancer screening have only dropped since 2012.

"The low prevalence of discussions about lung cancer screening and lack of association with smokers' intents and attempts to quit are surprising," said Jinhai Huo, MD, PhD, MSPH, assistant professor in the Department of Health Services Research, Management and Policy at the University of Florida in Gainesville, in a prepared statement. "Our results suggest that lung cancer screening is substantially underutilized and not reaching high-risk smokers who would benefit the most.

Huo and colleagues looked at 9,433 individuals surveyed as part of the National Cancer Institute’s Health Information National Trends Survey (HINTS) in 2012, 2014 and 2017, directly after the National Lung Screening Trial and the releasee of the United States Preventative Services Task Force and CMS screening recommendations. HINTS surveyed respondents on whether they had discussed a lung cancer test in the past year and whether they were a smoker.

The rate of discussions were “very low,” falling from 6.7% in 2012 to 4.3% in 2017. Broken down by age and smoking status, Huo et al. found the highest discussion rates in 2017 occurred with smokers older than 74 years (22.1%), smokers 55-74 (17.9%) and former smokers older than 74 (16.3%). Multivariable analysis found screening conversations were not associated with current smokers’ intent to quit within six months or past attempts.

According to the researchers, lung cancer screening is particularly effective in reducing mortality for current or former heavy smokers aged 55-77 with a 30-year history of smoking as well as those with a 20-pack-year history and other factors such as family history or environmental exposure.

Current smokers were more likely to have discussions if they were non-Hispanic Blacks, Hispanic, covered by insurance or patients diagnosed with heart or lung disease.

"More physicians need to initiate a shared decision-making process with their patients who want to have or are eligible for lung cancer screening to reduce the risk of mortality associated with lung cancer," Huo said in the statement. "For eligible high-risk smokers, a low-dose CT scan can reduce the risk of mortality. For moderate- and low-risk smokers, there is no clinical evidence demonstrating that the benefits of screening outweigh the harms. However, smoking cessation discussions should still be taking place as a high priority."