WEDNESDAY, May 18, 2022 (HealthDay News) — Annual lung cancer screenings are strongly encouraged for men and women at high risk of lung cancer. But new research finds that of those evaluated, nearly half fail to seek immediate follow-up care when a CT scan picks up a potential problem.
Study author Dr. Matthew Triplett said the statistics were worrying, stressing that “the whole goal of lung cancer screening is to detect cancers when they are small, localized and treatable.” He is an assistant professor at the Cancer Care Alliance in Seattle and the Fred Hutchinson Cancer Research Center.
“I am concerned that if patients have troubling findings and do not receive timely follow-up, they risk letting the cancer progress, even though we know it is,” Triplett added.
State that low-dose CT scans can reduce lung cancer mortality by up to 20%, the US Preventive Services Task Force (USPSTF) recommends screening for high-risk patients each year.
The USPSTF defines “high risk” as adults between the ages of 50 and 80 who are either current heavy smokers or have stopped smoking in the previous 15 years.
Excessive smoking is defined as one pack a day for 20 years or two packs a day for 10 years.
“At best, we screen about 10% of patients currently eligible in the United States,” Triplette said. The USPSTF puts that number at less than 6% nationally, with rates as high as 18% in Massachusetts, but as low as 1% in California. Wyoming.
But when these people are screened, what do they do next?
To find out, between 2012 and 2021, researchers tracked nearly 400 patients enrolled in Seattle’s annual CT scan program.
All had lung cancer screenings that identified the type of high-risk outcome that was recommended for follow-up – in the form of a second CT scan, meeting with a specialist and/or additional procedures.
The study team noted that time is of the essence when follow-up is warranted. But 47% of patients who needed follow-up significantly delayed doing so. ‘Delay’ means waiting more than a month after the recommended time frame, and/or more than 30 days after screening for those patients whose initial results were considered particularly worrisome.
The investigators found that the average delay was 91 days.
The team noted that current smokers delayed follow-up for longer than former smokers, although those with particularly problematic results delayed follow-up for shorter periods.
The good news is that most patients were eventually disease-free.
In fact, Triplett emphasized, “most of these patients will not actually have lung cancer, only about 15% of those with positive test results.” “Most patients just need to have a follow-up CT scan early, to make sure the suspicious nodules haven’t grown or changed.”
Triplette admitted he was “not quite sure” why patients put off follow-up care. But he noted that barriers to care – such as lack of insurance, transportation or access – may play a role for some. “I think patients may actually underestimate the importance of getting these tests done quickly,” he added.
But Dr. Jacob Sands, a chest oncologist at Harvard Medical School and the Dana-Farber Cancer Institute in Boston, said it was important not to blame patients “as if the patients themselves were unconcerned.”
Sands admitted that some patients “may fear that lung cancer is a death sentence. It’s scary to have a test or follow-up where you may find out you have lung cancer.”
That doesn’t fully explain what’s going on, said Sands, a spokesperson for the American Lung Association, who was not part of the study team.
He added that while the ongoing stigma against smokers likely also plays some role in lowering the numbers, this is only once part of the delay puzzle.
“In part, this is likely a reflection of primary care’s lack of understanding of the true benefits of lung cancer screening,” Sands suggested. “Unfortunately, teaching primary care physicians isn’t everything we hope it will be. And life is tough. People have a lot of things on their mind. And if your doctor doesn’t move quickly and aggressively to bring in patients, of course they won’t be motivated.”
The results were presented Tuesday at a meeting of the American Thoracic Society in San Francisco. Data presented at meetings should be considered preliminary until published in a peer-reviewed medical journal.
The American Cancer Society outlines the symptoms of lung cancer.
SOURCES: Matthew Triplett, MD, MA, public health, assistant professor, Division of Pulmonology, Critical Care and Sleep Medicine, Seattle Cancer Care Alliance and Fred Hutchinson Cancer Research Center; Jacob Sands, MD, Chest Oncologist, Harvard Medical School, Dana-Farber Cancer Institute, and Instructor, Medicine, Harvard Medical School, Boston, National Volunteer Speaker, American Lung Association; American Thoracic Society meeting, San Francisco, May 13-18, 2022