How Patients' Personal Preferences Can Factor Into Lung Cancer Screening
A new study focuses on how at-risk individuals weigh the trade-offs and risks of screening, and whether that should factor into the decision to screen
According to the Centers for Disease Control and Prevention, the only recommended screening test for lung cancer is low-dose CT, a newer type of CT scan that uses one-fifth the typical dose of radiation. Some physicians believe that screening should be restricted to patients at the highest risk for lung cancer death in order to minimize costs and harms from radiation. Others have a more liberal view of screening eligibility criteria and argue that those at lower risk should also be scanned.
The personal preferences of the patient add to the complexity of this issue, given that individuals will weigh the tradeoffs and risks of screening differently. Taking this into account, researchers from the University of Michigan performed a modeling analysis to determine the influential factors that should inform the screening decision for a given individual. The results were published by Annals of Internal Medicine May 29.
The authors created a Markov microsimulation model -- a computer program that mimics the behavior of individual members of a population -- based on data from the National Lung Screening Trial, a randomized study of 53,454 people at high risk for lung cancer. The model simulated a nationally representative sample of 1 million heavy smokers aged 55 to 80 years, who experienced either 3 years of annual low-dose CT screening or no screening.
The benefits of low-dose CT screening varied considerably across the population, but the results highlighted several factors as being highly influential. According to the model, patients at high annual risk for lung cancer were projected to have significant health gains as a result of screening, even for those with strong personal preferences against it. However, screening for people at lower risk or with a shorter life expectancy could depend more on their personal preferences, and how they weigh the risks and benefits of CT scans.
The researchers have also created a web-based decision tool intended to aid physicians in facilitating personalized discussions about lung cancer screening with their patients.