Lung cancer screening led to more downstream procedures, complications in practice than in research
In clinical practice, 31.9% of patients screened for lung cancer underwent downstream imaging and 2.8% had downstream procedures. Those undergoing invasive procedures after abnormal findings had a 30.6% complication rate, compared to 17.7% in the National Lung Screening Trial.
In routine clinical practice, there were substantially higher rates of downstream procedures and complications associated with lung cancer screening than seen in the National Lung Screening Trial (NLST), a study found.
Researchers studied 9,266 patients screened for lung cancer in five U.S. health care systems between 2014 and 2018 to identify rates of downstream imaging, invasive diagnostic procedures, and procedural complications. For each, absolute rates were calculated overall and stratified by screening result and by lung cancer detection. The study was published by Annals of Internal Medicine on Jan. 2.
Among all screened patients, 1,472 (15.9%) had a baseline low-dose CT showing abnormalities. Of those patients with abnormalities, 140 were diagnosed with lung cancer within 12 months (positive predictive value, 9.5% [95% CI, 8.0% to 11.0%]; negative predictive value, 99.8% [95% CI, 99.7% to 99.9%]; sensitivity, 92.7% [95% CI, 88.6% to 96.9%]; specificity, 84.4% [95% CI, 83.7% to 85.2%]).
Of all screened patients, 31.9% had downstream imaging and 2.8% had downstream procedures. Among patients who had invasive procedures after abnormal findings, complication rates were substantially higher than those in NLST (30.6% vs. 17.7% for any complication and 20.6% vs. 9.4% for major complications).
According to the study authors, the findings highlight the need for practice-based strategies to assess and improve variations in the quality of care and to prioritize lung cancer screening among patients most likely to benefit from it in relation to potential complications and other harms.
“The observed rate of overall complications in our equivalent population was 1.7 times higher than observed in NLST, a difference that could shift the balance of screening benefits and harms in community practice,” the authors wrote. “For future research, it is important to understand what factors may be driving any differences within and across health care systems and how they may contribute to overall harms and benefits from screening.”