BOSTON — With numerous practice guidelines urging the use of low-dose computed tomography (LDCT) screening for lung cancer — and the concept tested in a pilot project at the VA — how do pulmonologists feel about all of it?
That was the question raised by a study published last year in the Annals of the American Thoracic Society. The study, led by Boston University School of Medicine researchers and involving VAMCs from around the country, pointed out that pulmonologists play a central role in the planning of LDCT screening programs, and, therefore, their beliefs affect the safety, cost-effectiveness and success of any implementation of a screening program.1
To determine that, study authors conducted a national web-based survey, administered July 2013 to February 2014, among all staff pulmonologists active in VHA pulmonary clinics. Of 573 eligible pulmonologists emailed, 286 (49.9%) participated.
Results indicated that about half, 52.4%, had a propensity for guideline-concordant screening, 22.7% for over-screening and 24.9% for under-screening. Guideline concordance was associated with acceptance of trial evidence, guidelines and the efficacy of screening, according to the study.
Analysis indicated that the under-screeners were more likely to cite the potential harms of screening, such as false-positive findings, radiation exposure, incidental findings and unfavorable cost-benefit ratio as influential factors, for a relative risk of 3.9. They also were less influenced by trial evidence and guidelines, relative risk, 0.06, compared with guideline-concordant screeners.
Researchers noted that local resource availability did not significantly affect screening propensity, but insufficient infrastructure and personnel were commonly cited as barriers to implementation.
“Pulmonologists have varied perceptions of the evidence and trade-offs of LDCT screening, leading to the potential for over- and under-screening,” study authors concluded. “To minimize potential harms as LDCT screening is widely implemented, physicians must understand which patients are appropriate candidates and engage those patients in a shared decision-making process regarding the trade-offs of LDCT screening.”
1 Iaccarino JM, Clark J, Bolton R, Kinsinger L, Kelley M, Slatore CG, Au DH, Wiener RS. A National Survey of Pulmonologists’ Views on Low-Dose Computed Tomography Screening for Lung Cancer. Ann Am Thorac Soc. 2015 Nov;12(11):1667-75. doi: 10.1513/AnnalsATS.201507-467OC. PubMed PMID: 26368003.