Low screening rates highlight a ‘major issue’ with lung cancer
CHICAGO —Less than 2% of the more than 7 million current and former heavy smokers eligible for lung cancer screening underwent screening at accredited sites, according to data presented at the ASCO Annual Meeting.
“This study highlights a major issue we have with lung cancer in the United States in general,” Hossein Borghaei, DO, MS, division chief of thoracic medical oncology at Fox Chase Cancer Center, told HemOnc Today. “I think that’s the fact that a lot of practitioners still have this view about lung cancer that once a patient has a diagnosis, things are bad, and outcomes are bad. I really think this lack of screening or paying attention to screening comes a little bit from all of these older sorts of interpretation of how bad lung cancer survival is.”
Danh Pham, MD, medical oncologist at the James Graham Brown Cancer Center at University of Louisville, and colleagues analyzed screening rates following expanded insurance coverage using data from the 2016 American College of Radiology’s Lung Cancer Screening Registry for 1,796 accredited screening sites. They used 2015 data from the National Health Interview Survey to determine the number of screening-eligible current or former smokers.
Results showed 7,612,975 current and former heavy smokers were eligible nationwide for screening. However, only 1.9% of eligible people (n = 141,260) underwent screening at the accredited sites.
Borghaei said there is no direct reason to point to as to why screening is low, but he did acknowledge that he is significantly bothered by the results.
“Even though there are other experts in the field who somewhat argue that the one study that was published that showed a 20% reduction in lung cancer-related mortality is not sufficient, is not enough and may need other studies, it still is the best screening method we have been able to come up with, other than smoking cessation,” he said.
When data similar to these results become available, Borghaei said he questions whether information is correctly disseminated and if experts are talking to the right physicians who are likely seeing and screening patients with lung cancer.
The question is, are there educational or methodological gaps in disseminating information, which is why there’s such a low screening rate, Borghaei added.
“I think when I go around and talk with other doctors, especially pulmonologists who see patients who are smokers and who have COPD, they know the data,” he said. “A lot of community places have screening programs – at least around where I’m based – and the study highlighted that there is some geographic variation, but honestly I cannot figure out what else there could be that leads to this low screening rate.”
What’s additionally troubling about these data, according to Borghaei, is that current screening methods should help physicians screen more patients and catch the disease at an earlier stage where the belief is that the cure rates are higher.
“I think we need to do a full survey of primary care physicians, and pulmonologists and try and figure out what their attitudes are toward screening and if they are aware of the data and recommendations to do a low-dose CT in patients who are at high-risk,” Borghaei said.
Since 2013, the United States Preventive Services Task Force recommended people aged 55 to 80 years who are current or former heavy smokers — defined as at least 30 cigarette pack-years — be screened for lung cancer using low-dose CT.
“There are enough of these national guidelines that suggest we should be doing this,” Borghaei said. “I think mostly oncologists look at these guidelines. Well, the oncologists are already a captured audience, they are in support of this. I think we need to do a better job of training PCPs, family practice, nurse practitioners who are in the community, pulmonologists who are in the community to say, ‘look, this works and there is a way to reduce the lung cancer mortality.’” – by Ryan McDonald
Pham D, et al. Abstract 6504. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.
Disclosures: Borghaei reports no relevant financial disclosures.