CONTENT

1.1 Lung Cancer Screening
1.2 Potential Risks of Screening
1.3 Patient Participation in Lung Cancer Screening

Forward to 1E Evidence to support Screening Back to 1C Signs and Symptoms of Lung Cancer.

I’m reading a book about anti-gravity, it’s impossible to put down.

1.1 Lung Cancer Screening

Screening means testing for the early stages of cancer before an individual has any signs and symptoms. Screening is now an important part of health care and is as a means of early detection of some important cancers, such as breast cancer and cervical cancer.

Screening programs require an accurate ‘first-stage’ diagnostic screening test (imaging). The test used must reliably detect cancer (lung). The first-stage screening test should give a low  ‘false negative’ rate;  that is, it should be sensitive and not miss abnormalities.

The ‘first-stage’ test should not give false positive results. However, some false-positives are thought to be acceptable if a first-stage screening test is to have a low ‘false-negative’ rate; that means that it is less likely to miss cancers that are present.

I’d rather have a false positive than a false negative.

Me too, but I’d rather just have a true negative result.

Don’t let any negatives into your head, raise the rent and kick them out!

1.2 Potential Risks of Lung Cancer Screening

Lung cancer screening has three main risks:

1)   ‘False-Positive’ Diagnoses: A lung cancer screening test can suggest that a person has lung cancer when no cancer is present. This is a ‘false-positive’ result. False-positive results can lead to follow-up tests and surgery that are not needed, and that may carry even more risks.

2)   Over-Diagnosis: A lung cancer screening test can find abnormalities that may never have caused a problem for the patient. This is called ‘overdiagnosis.’ Overdiagnosis can lead to treatment that is not needed.

3)   Radiation: CT imaging uses X-rays. Repeated (low dose) computed tomography (CT) tests can cause cancer in otherwise healthy people. In 2011, the Radiologic Society of North America and the American Association of Physicists in Medicine issued a statement that:

‘Risks of medical imaging at effective doses below 50 mSv for single procedures,  or 100 mSv for multiple procedures over short time periods are too low to be detectable and may be non-existent. Predictions of hypothetical cancer incidence and deaths in patient populations exposed to such low doses are highly speculative  and should be discouraged.’ See full statement.

That is why lung cancer screening is recommended only for adults who have no symptoms but who are at high risk of developing the disease (because of their smoking history and age).

What are the most important criteria for lung cancer screening?

You should be 55 to 74 years old, have at least a 30 pack-year smoking history, still smoke, or have stopped within the last 15 years.

There you go, if you fit into those groups you can ask your doctor for information about lung cancer screening near you.

1.3 Patient Participation in Lung Cancer Screening

Earlier diagnosis of lung cancer is the key factor in reducing mortality. However, recent studies, including the 2012 LUNG-SEARCH trial, have shown that smokers may have a negative attitude to screening. This may explain why participation in lung cancer screening trials has been poor (< 1 in 6 of those eligible).

Understanding participation is important since uptake in screening trials is likely to predict uptake in screening programs.

The decision by an individual to participate in a screening program depends on many factors.  These may include the convenience of screening methods, perception of their risk of cancer, and self-interest. Sputum provision, CT scanning and bronchoscopy have been shown to be acceptable to those participating in a screening trial but need to be evaluated for screening programs.

Changing an individual’s attitude to participation may be key to improving participation in lung cancer screening.

Well, you know what they say. You can stick that in your pipe and smoke it!

REFERENCES:

Berrington de González A, Darby S. (2004). Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries.  Lancet. 363(9406), 345–351. (Retrieved 22^nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/15070562

Strauss GM. (1999). Screening for lung cancer: an evidence-based synthesis. Surg Oncol Clin N Am. 8(4), 747-74. (Retrieved 22^nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/10452939

More references for this section are on this page.

PATIENT INFORMATION:

Center for Disease Control and Prevention (CDC) What Screening Tests Are There? (Retrieved 22^nd Jan 2015): http://www.cdc.gov/cancer/lung/basic_info/screening.htm

Lung Cancer Alliance What do I need to know about Risk? (Retrieved 22^nd Jan 2015):  https://lungcanceralliance.org/risk-early-detection/about-screening/

More patient information for this section is on this page.

Forward to 1E Evidence to support Screening Back to 1C Signs and Symptoms of Lung Cancer.