The potential risks of lung cancer screening are often left out when doctors and patients discuss the issue, a new report suggests. In South Africa, lung cancer accounts for 17% of cancer-related deaths. 

Early detection of lung cancer can save lives, and lung cancer screening is recommended for high-risk current and former smokers. But the US Preventive Services Task Force and other organisations say that doctors need to explain the risks as well as the benefits to patients.

Those risks include a high rate of false positives, which can lead to unnecessary follow-up procedures. And in some cases, screening can reveal lung cancer that, left untreated, would not have affected patients in their lifetime, the study authors said.

In this study, researchers analysed 14 recordings of doctors and patients discussing lung cancer screening. On average, the talks lasted less than a minute, the quality of the conversations was poor, and discussion about the potential harms of screening was “virtually non-existent”, the investigators found.

The findings were published in the journal JAMA Internal Medicine.

Complex screenings

“We’re not taking a side as to whether lung cancer screening is good or bad, but there seems to be a consensus that we should be sharing these complex decisions with patients,” said study senior author Dr Daniel Reuland.

“Our fly-on-the-wall sample from real-world practice shows us that’s not happening,” he added. Reuland is director of the Carolina Cancer Screening Initiative at the UNC Lineberger Comprehensive Cancer Center in Chapel Hill.

“A lot of people [with positive screening results] undergo surveillance, additional scanning, and some people undergo invasive procedures who don’t have lung cancer,” Reuland said in a University of North Carolina news release.

Potential harms and benefits

“The problem is weighing a small chance of benefit in the form of prolonged life versus a larger chance that a given patient will incur some kind of physical or psychological harm, plus out-of-pocket costs. It’s important to talk about those potential harms and benefits with patients when deciding about screening,” he suggested.

The US Preventative Services Task Force recommends annual lung cancer screening using low-dose computed tomography (CT) for adults 55 to 80 years old who have been heavy smokers.

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