[ad_1]
This transcript has been modified for clarity.
Hi everybody. I am Dr. Kenny Lin. I am a family doctor at the Georgetown University Medical Center and I blog on the Common Sense Family Physician.
Four and a half years ago, I recorded my first comment in Medscape on shared decision-making strategies with eligible patients for a low-dose scanner for lung cancer screening. At that time, few patients were screened and only one study, the National Lung Screening Trial (NLST), had shown that screening saved lives. The Centers for Medicare & Medicaid Services had just started paying for the scanner for people aged 55 to 77 with at least 30 years of smoking experience and who still smoked or had quit in the past 15 years years. Primary care community members also expressed concerns about NLST results translated into community practice and whether rates of false positives, overdiagnosis and complications could be higher outside the scope of the NLST. controlled trials.
An badysis of data from the 2017 Behavioral Risk Factor Surveillance System in 10 states found that 14% of eligible adults screened had undergone a low dose CT scan of lung cancer in the last 12 months.[1] This modest use is likely related to several factors, such as the refusal to screen well-informed patients and the gradual implementation of a relatively new test. On this last point, a recent study[2] provided some badurance. A survey of 165 lung cancer screening centers in US communities found that screening protocols, outcomes, and management of abnormal results were similar to those at academic medical centers.[2] These screening centers have developed a variety of mechanisms to ensure that all eligible patients receive a shared consultation and decision visit, and are provided with resources to quit smoking, as appropriate. .
Two other randomized lung cancer screening trials confirmed the findings of the NLST. In the multicentric detection test of the Italian lungs,[3] approximately 4000 participants were randomized to receive an annual or biennial LDCT or no screening over a median of 6 years. After 10 years, lung cancer mortality in the LDCT groups was reduced by 39%, with a number needed to screen 167 to prevent a lung cancer death. In particular, one in three participants was under the age of 55 and one in four had used less than 30 years of cigarette packs. Other publications from this group should provide information on the advantages and disadvantages of screening in low-risk adults.
In the German study on lung cancer screening,[4] 4000 adults aged 50 to 69 who had smoked at least 15 cigarettes a day for 25 years or 10 cigarettes a day for 30 years were randomized to form five annual cycles of TLDs or a control group. After about 9 years, there was no statistical difference in lung cancer mortality in general, but a limited badysis for women revealed lower lung cancer mortality among screened participants.
A prospective cohort study[5] in 12 states in the south of the country, evaluated the effectiveness of the guidelines of the American Task Force on Preventive Services to identify people likely to develop lung cancer. A lower percentage of smokers who identified themselves as African-Americans were eligible for screening compared to smokers identified as Caucasian, due to the lower number of smoking-pack years among African-Americans. years. However, Dr. Otis Brawley, an oncologist at Johns Hopkins University and former Chief Medical Officer at the American Cancer Society, cautioned against interpreting this study as evidence of a biological difference in lung cancer in individuals black and white. The underlying explanation is far more likely to be cultural or socio-economic.
While these new findings increase our confidence that lung cancer screening has a net benefit for some high-risk patients, it does not make shared decision making less necessary. Last year, a study[6] have suggested that primary care clinicians have too many unilateral discussions, focusing almost exclusively on the benefits of lung cancer screening. It is essential to inform patients that many cancers actually detected by the TLD – from 18% to 67%, according to the study – are over-diagnosed and would not have become clinically evident over the life of the patient.[7] Patients with these tumors can not benefit from cancer detection and can only suffer damage. The potential benefits of LDCT may still be worth taking, but it is up to each patient to decide.
It's Dr. Kenny Lin for Medscape Family Medicine. Thank you for your attention.
Follow Medscape on Facebook, Twitter, Instagram and YouTube
[ad_2]
Source link
