Many Docs Order Unneeded Lung Cancer Screening Tests: Survey
TUESDAY, March 13 (HealthDay News) -- Contrary to current guidelines, a majority of American primary care physicians are ordering some form of lung cancer screening test for patients who lack any symptoms of disease, a new national survey reveals.
The findings stems from responses to a questionnaire completed by 962 family physicians, general practitioners and general internists between 2006 and 2007.
"There is no authoritative group that is recommending lung cancer screening for asymptomatic individuals," said study author Carrie Klabunde, an epidemiologist from the applied research program within the division of cancer control and population sciences at the U.S. National Cancer Institute.
"And guidelines are developed by expert groups that generally have a very thoughtful process for evaluating scientific evidence and for coming to a consensus," she added. "So, it's important to be aware of what the guidelines for lung cancer screening are. Because in this case, the available screening technology really hasn't shown a strong benefit, and when used improperly can lead to what may end up being a medical misadventure."
The findings appear in the March/April issue of the Annals of Family Medicine.
In the United States, lung cancer is currently the leading cause of death due to cancer, according to study background information. Survival rates are much lower for lung cancer than for many other types of cancer.
That said, fresh concerns about pointless lung cancer screening raised by the new poll follow a related U.S. National Cancer Institute (NCI) analysis conducted last fall using data on more than 150,000 people. It concluded that chest X-rays are of no benefit when it comes to screening for lung cancer or curtailing lung cancer mortality, although more expensive CT scans were cited as a potentially more effective option.
The current study team said that no vetted investigation has ever shown that X-ray screenings help to lower the risk of dying from lung cancer.
Apart from wasting medical resources, unnecessary screening can do more harm than good, experts say. False test results can cause undue patient stress and false positives can raise the risk for patient harm resulting from unneeded and invasive treatment.
As a result, experts do not currently recommend a lung cancer screening for a patient who does not show signs of disease, even if that patient has a history of heavy smoking.
Klabunde and her colleagues mailed out a survey to assess the frequency and physician rationale behind the ordering one of three different lung cancer screening techniques: chest X-ray, low-radiation dose spiral CT scan and/or sputum cytology (a lab test).
All the respondents were 75 years old or younger and currently in practice.
The result: 57 percent of those polled said they had ordered at least one of the three tests in the past year for patients who lacked lung cancer symptoms.
The study team found that fully a quarter of the polled physicians said they mistakenly believed that one or more of the relevant national expert organizations (including the U.S. Preventive Services Task Force, the American Cancer Society, the American College of Radiology, the American Thoracic Society and the NCI) did in fact recommend lung cancer screening for patients with no symptoms.
Those who believed this to be the case were more likely to have ordered screening tests. Similarly, those doctors who themselves believed that such testing was effective and, therefore, something they would recommend for asymptomatic patients were also more likely to order the tests.
Physicians whose patients had specifically inquired about getting a lung cancer screening were also more likely to order a test. Two-thirds of physicians said that at least one of their patients had questioned them about screening in the year leading up to the poll.
The survey team concluded that the apparent "disconnect" between expert screening guidelines and common physician practice raises the need for improved outreach to educate primary care physicians about best practices, as well as continued monitoring of what's actually going on in doctor's rooms across the country.
"Primary care physicians have to know about so many different areas," Klabunde acknowledged. "And there are a lot of guidelines for preventive services. So it's a lot to keep in his or her head."
"But one thing that I think will help going forward are electronic medical records systems," she said. "Many of which, although not all, have decision-support features. And this can provide physicians who are considering ordering a screening with electronic links to practice guidelines."
Dr. Otis Webb Brawley, chief medical officer and executive vice president of the American Cancer Society, said that it's important to understand that screening can be a "double-edged sword."
"I am constantly concerned when we promote the benefit of screenings, and don't worry about the fact there might be associated harm," he said.
"I would say, however, that most of the doctors in this survey have been practicing for 25 or 30 years," Brawley noted. "And because we are starting to teach about screening in school now I am somewhat hopeful that the word will get out among younger physicians. But I would also say that the only way we're really going to get doctors better on this question is actually by encouraging patients to turn to the large major established organizations like us and the NCI - and get more educated about the facts."
For more on lung cancer, go to the U.S. National Library of Medicine.
SOURCES: Carrie N. Klabunde, Ph.D., epidemiologist, applied research program, division of cancer control and population sciences, U.S. National Cancer Institute, Bethesda, Md.; Otis Brawley, M.D., chief medical officer and executive vice president, American Cancer Society, Atlanta; March/April 2012 Annals of Family Medicine