Lung Cancer Screening Will Not Increase Surgical Intervention

Research may minimize operations for benign disease while maintaining a low morbidity and mortality for surgical resection.

Lung cancer screening programs that use standardized reporting and involve cardiothoracic surgeons as part of the multidisciplinary team can be adopted into clinical practice without having an increase in surgical intervention for non-cancerous disease.

Past studies have shown that lung cancer screening with low-dose computed tomography (LDCT) can reduce lung cancer mortality rates in high-risk patients by 20%. Because of this, private insurers and the Centers for Medicare & Medicaid Services (CMS) agreed to pay for LDCT lung cancer screening for select patients, but those in opposition stated false positive results could lead to unnecessary treatment.

The study reviewed surgical outcomes in 1654 patients who underwent LDCT lung cancer screening between January 2012 and June 2014.

“Surgical intervention for a non-lung cancer diagnosis was rare—5 out of 1654 patients or 0.30%,” said Bryan L. Walker, BS, lead researcher. “That incidence is comparable to the 0.62% rate found in the National Lung Screening Trial that helped secure screening coverage in the [United States].”

Only 4 of the 1654 patients underwent surgical intervention for benign disease.

The researchers developed a standardized reporting system, which they called the Lung Imaging Reporting and Data System, to help categorize patient screening results.

If the results are categorized as highly suspicious, a team of doctors, including board certified cardiothoracic surgeons, made recommendations about whether the patient should have continued follow-up with LDCT, additional diagnostic testing, or surgical intervention.

Of the patients in the study, only 25 received surgery, 20 were diagnosed with lung cancer, and 18 had early stage disease with a high probability of being cured.

The American Cancer Society estimates that more than 221,000 new cases of lung cancer will be diagnosed in 2015 in the United States alone, and more than 158,000 people will die from the disease, which is the highest mortality rate of any cancer.

“Lung cancer screening saves lives, and our study serves as a model for how to set up a screening program that is safe and effective for patients,” said Christina Williamson, MD, lead researcher from Lahey Hospital & Medical Center in Burlington, Mass. “A screening program should use a standardized reporting system and have input from board-certified cardiothoracic surgeons as part of a multidisciplinary team evaluating CT scan findings. It is only by minimizing the number of operations for benign disease and maintaining a low morbidity and mortality for surgical resection that the full benefit of lung cancer screening can be realized in its widespread adoption in clinical practice.”