Evidence review examines both benefits and harms for lung cancer
screening

Date:
March 10, 2021
Source:
UNC Lineberger Comprehensive Cancer Center
Summary:
A comprehensive review shows there are both benefits and harms
from screening.



FULL STORY ==========================================================================
A comprehensive review by University of North Carolina researchers and colleagues of hundreds of publications, incorporating more than two
dozen articles on prevention screening for lung cancer with low-dose
spiral computed tomography (LDCT), shows there are both benefits and
harms from screening. The review is published in JAMA on March 9, 2021.


==========================================================================
The results of the decade-long National Lung Screening Trial (NLST)
showed that LDCT could detect lung cancer better than conventional
X-rays in current or previous heavy smokers. Based on those results,
the United States Preventive Services Task Force (USPSTF) initially
recommended low-dose CT screening for people ages 55 to 80 with a 30
pack-year smoking history. Subsequently, other screening trial results
have been published, including a European trial called NELSON, the
next-largest study to the NLST. NELSON also found a reduction in deaths
due to lung cancer because of screening.

It has been nearly a decade since the initial recommendations were
formulated, so the USPSTF initiated an updated review of the evidence. UNC scientists and their collaborators evaluated and synthesized data from
the seven trials to arrive at a comprehensive, current assessment of
harms and benefits of screening.

New recommendations, based on this evidence review, broaden the criteria
for screening eligibility by lowering the screening age from 55 to 50 and reducing the pack-year requirement from 30 to 20 pack-years. There were
several reasons for this change in eligibility according to the reviewers;
one was to promote health equity, in part because African Americans have
higher lung cancer risk even with lower levels of smoking exposure.

"Two large studies have now confirmed that screening can lower the chance
of dying of lung cancer in high-risk people. However, people considering screening should know that a relatively small number of people who are
screened benefit, and that screening can also lead to real harms," said
Daniel Reuland, MD, MPH, one of the review authors, a member of the UNC Lineberger Comprehensive Cancer Center, and a professor in the division
of General Medicine and Clinical Epidemiology at UNC School of Medicine.

In screening with CT scans, doctors are looking for lung spots or
nodules that might represent early lung cancer. Harms from screening
can come from the fact that the large majority of the nodules found on screening are not cancer. These findings are known as false positives,
and patients with these results usually require additional scans to see
if the spots are growing over time. In some cases, these false positives
lead to unnecessary surgery and procedures.

Throughout the process, patients may experience the mental distress of
a possible cancer diagnosis.

"Applying screening tests to a population without symptoms of disease
can certainly benefit some people but also has the potential for some
harms," said lead author Daniel Jonas, MD, MPH, who conducted most of
this research while he was a professor at the UNC School of Medicine
and now is director of the division of general internal medicine at Ohio
State University. "In the case of lung cancer screening, we now have more certainty that some individuals will benefit, with some lung cancer deaths prevented, and we also know others will be harmed. The USPSTF has weighed
the overall benefits and harms, and on balance, based on our review and
from modeling studies, has determined that screening with LDCT has an
overall net benefit for high-risk people ages 50 to 80." Reuland and
Jonas note that, encouragingly, lung cancer rates are declining,
reflecting changing smoking patterns in recent decades. Therefore,
the population eligible for screening is also projected to decline. At
this point, however, they don't foresee these trends changing screening recommendations during the next decade or so.

"Different trials have used different screening approaches, and
we still do not know how often screening should be done or which
approach to categorizing lesions is best for reducing the harms,
costs and burdens of screening while retaining the benefits," said
Reuland, who is also a research fellow at UNC's Cecil G. Sheps
Center for Health Services Research. "I would prioritize this
as an important area of future research, as it could likely
be addressed by implementing less expensive studies or using
approaches other than those used in the large trials we just reviewed." ========================================================================== Story Source: Materials provided by
UNC_Lineberger_Comprehensive_Cancer_Center. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Daniel E. Jonas, Daniel S. Reuland, Shivani M. Reddy, Max Nagle,
Stephen
D. Clark, Rachel Palmieri Weber, Chineme Enyioha, Teri L. Malo,
Alison T.

Brenner, Charli Armstrong, Manny Coker-Schwimmer, Jennifer Cook
Middleton, Christiane Voisin, Russell P. Harris. Screening for
Lung Cancer With Low-Dose Computed Tomography. JAMA, 2021; 325
(10): 971 DOI: 10.1001/jama.2021.0377 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/03/210310084725.htm

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