Lung cancer tests risky
Procedures to check for lung cancer can lead to complications, study reveals
INVASIVE follow-up tests to examine abnormalities found with lung cancer screening may lead to more complications and extra health care costs than doctors previously thought, a US study suggests.
Many doctors advise older adults who are current or former smokers to get annual lung cancer screening with low-dose computed tomography (LDCT) based on a pivotal 2011 trial reporting 20% lower lung cancer mortality rates than when screening was done with chest X-rays.
With LDCT, however, more than one in four patients get so-called false-positive results, when they’re told they have potentially malignant abnormalities that turn out to be benign.
For the current study, researchers examined nationwide data on 344 510 patients, aged 55 to 77, who had invasive diagnostic procedures to look for lung cancer between 2008 and 2013.
Overall, about 22% of patients younger than 65 in the study had complications, as did almost 24% of the older people in the study.
These complication rates were more than twice as high as those reported in the 2011 LDCT lung cancer screening study responsible for current screening recommendations, researchers reported in Jama Internal Medicine.
“Although the screening itself may carry minimal risk, the downstream events can be harmful,” said senior study author Ya-chen Tina Shih of the University of Texas MD Anderson Cancer Centre in Houston.
“It is difficult to pinpoint what causes complications after these invasive procedures because they include a large list of conditions and invasive procedures include a wide variety of diagnostic procedures from needle biopsy to thoracic surgery,” Shih said.
Complication rates in the study ranged from about 19% after needle biopsies to as high as 52% after surgery.
Costs of these complications ranged from an average of $6320 (R86700) to $56 845 and varied by severity, patient age, and type of follow-up procedure.
The study wasn’t designed to prove whether or how invasive tests after screening cause complications or increase costs. The study also relied on insurance claims data, not medical records, and it’s possible this may have underestimated minor complications, the authors note.
Another drawback of the study was that it didn’t distinguish between patients with and without symptoms, said Dr Hossein Borghaei of Fox Chase Cancer Centere in Philadelphia.
“A symptomatic patient who undergoes a procedure for a diagnostic purpose is different and could have more complications compared to an individual (without symptoms) who is being screened for this disease,” Borghaei, who wasn’t involved in the study, said.
Even so, the results offer fresh evidence that the 2011 trial done at academic medical centres might not reflect outcomes at community hospitals where many patients get care, said Dr Dan Reuland of the University of North Carolina at Chapel Hill School of Medicine.
“Complications from invasive chest procedures could happen more frequently in community practice,” Reuland, who wasn’t involved in the study, said.
With the potential for complications after follow-up tests, patients should consider whether they are among those most likely to benefit from screening, said Dr Mark Ebell, a researcher at the University of Georgia in Athens who wasn’t involved in the study.
“The patients most likely to experience a net benefit are those aged 60 to 69 who are current smokers,” he said.
“Older patients often have more health problems that limit their ability to benefit from screening, and those who have quit smoking 5 to 10 years ago are at significantly lower risk.”