A cancer screen­ing flop: Few smok­ers seek free lung scans

The Trentonian (Trenton, NJ) - - BUSINESS - By Marilynn Marchione

Lung cancer screen­ing has proved to be stun­ningly un­pop­u­lar. Five years af­ter gov­ern­ment and pri­vate in­sur­ers started pay­ing for it, less than 2 per­cent of el­i­gi­ble cur­rent and for­mer smok­ers have sought the free scans, re­searchers re­port.

The study didn’t ex­plore why, but ex­perts say pos­si­ble ex­pla­na­tions in­clude wor­ries about false alarms and fol­low-up tests, a doc­tor visit to get the scans cov­ered, fear and de­nial of the con­se­quences of smok­ing and lit­tle knowl­edge that screen­ing ex­ists.

“Peo­ple are not aware that this is a test that can ac­tu­ally save lives,” said Dr. Richard Schilsky. “It’s not in­va­sive, it’s not pain­ful, there’s no prep, noth­ing has to be stuck into any body cav­ity,” so to see so lit­tle use “is shock­ing.”

Schilsky is chief med­i­cal of­fi­cer of the Amer­i­can So­ci­ety of Clin­i­cal On­col­ogy, which re­leased the study Wed­nes­day in ad­vance of the group’s meet­ing next month.

Lung cancer is the top cancer killer world­wide, caus­ing 155,000 deaths in the United States each year. It’s usu­ally found too late for treat­ment to suc­ceed.

A big study found that an­nual low-dose CT scans, a type of X-ray, could find cases sooner and lower the risk of dy­ing of lung cancer by 20 per­cent for those at high­est risk. That’s peo­ple ages 55 through 79 who smoked a pack of cig­a­rettes a day for 30 years or the equiv­a­lent, such as two packs a day for 15 years.

In 2013, a gov­ern­ment task force and oth­ers backed screen­ing for such folks. The scans cost $100 to $250 and are free for those who meet the cri­te­ria, but peo­ple must have a spe­cial ap­point­ment to dis­cuss risks and ben­e­fits with a doc­tor.

Dr. Danh Pham at the Uni­ver­sity of Louisville in Ken­tucky and oth­ers got in­for­ma­tion on how many scans were done from an Amer­i­can College of Ra­di­ol­ogy reg­istry of all 1,800 sites in the U.S. ac­cred­ited to per­form them. A fed­eral health study was used to es­ti­mate how many cur­rent and for­mer smok­ers were el­i­gi­ble.

The re­sults: In 2016, less than 2 per­cent of 7.6 mil­lion el­i­gi­ble smok­ers were screened. Rates ranged from 1 per­cent in the West to 3.5 per­cent in the North­east.

That’s way be­low the 60 per­cent to 80 per­cent rates for breast, colon or cer­vi­cal cancer screen­ing.

The study was spon­sored by the Bris­tolMy­ers Squibb Foun­da­tion. One study leader has con­sulted for the com­pany and other cancer drug­mak­ers.

Mary Ba­roody of Alexan­dria, Vir­ginia, has had sev­eral scans at MedS­tar Ge­orge­town

Uni­ver­sity Hos­pi­tal since her hus­band, Michael, was di­ag­nosed with lung cancer and suc­cess­fully treated seven years ago. Both are 71 and long­time smok­ers who quit 15 years ago.

“I’m glad to go do it and I feel good after­ward,” she said of get­ting screened. “You get a clean bill of health. What else could you want?”

Her hus­band said screen­ing “just seems to be a no-brainer” be­cause it can find cancer when it’s most treat­able.

“I’m liv­ing proof, lit­er­ally, that caught early you can do some­thing about it,” he said.

But screen­ing has a dark side: re­search shows that over three years of an­nual scans, 40 per­cent of peo­ple will have an ab­nor­mal find­ing that often leads to fol­low-up tests such as a lung biopsy, and com­pli­ca­tions of those can be fa­tal, said Dr. Otis Braw­ley, the Amer­i­can Cancer So­ci­ety’s chief med­i­cal of­fi­cer.

“I’m com­mit­ted to telling peo­ple the truth and let­ting peo­ple de­cide for them­selves,” Braw­ley said, but added that if he were a can­di­date for screen­ing, “I don’t think I would do it.”

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