Comparison of observed harms and expected mortality benefit for persons in the veterans health affairs lung cancer screening demonstration project

Caverly TJ, Fagerlin A, Wiener RS, Slatore CG, Tanner NT, Yun S, Hayward R. JAMA Intern Med. 2018 Jan 22. [Epub ahead of print] [CrossRef] [PubMed]

In a follow-up research letter to a study published last March, VA researchers are reporting a very high false-positive screening rate with low-dose computed tomographic screening compared to the National Lung Screening Trial (58.2% vs 26.3%) (1-2). In the present study 2084 patients agreed to screening. The subjects were divided into quintiles of about 400 subjects using the Bach risk assessment tool (age, gender, pack-years, smoking status, asbestos exposure) for assessing lung cancer risk (3). Patients in the highest quintiles of lung cancer risk had significantly more lung cancers diagnosed (29.7 lung cancers per 1000 screened in quintile 5 vs. 4.8 in quintile 1) supporting the model's risk stratification. The initial screen was least efficient for patients in quintile 1 (2749 false-positive results and 68 nonbeneficial diagnostic procedures per lung cancer death prevented) and most efficient for those in quintile 5 (363 false-positive results and 22 nonbeneficial diagnostic procedures per death prevented). Quintiles 2-4 had intermediate results between the lowest and highest risk quintiles. The authors state, “These real-world findings reinforce the need to risk stratify patients for lung cancer screening and provide support for personalized, risk-based harm-benefit estimates for all eligible persons during lung cancer screening decision-making”.

References

1. Kinsinger LS, Anderson C, Kim J, et al. Implementation of lung cancer screening in the Veterans Health Administration. JAMA Intern Med. 2017;177(3):399-406. [CrossRef] [PubMed]
2. Aberle DR, Adams AM, Berg CD, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. [CrossRef] [PubMed]
3. Memorial Sloan Kettering Cancer Center. Lung cancer screening decision tool. Available at: https://www.mskcc.org/cancer-care/types/lung/screening/lung-screening-decision-tool (accessed 1/23/18).