Don’t forget the F/U after your lung cancer screening

For the last 10 years, the U.S. Preventive Services Task Force has advised that adults between the ages of 50 and 80 who have a 20 pack-year smoking history and currently smoke (or have quit within the past 15 years) should receive a low-dose computed tomography (CT) every year to check for lung cancer.

Putting these recommendations into practice has been challenging, though, per new research by Fred Hutchinson Cancer Center.

“There’s actually a large benefit in terms of early detection in lung cancer mortality for an annual low-dose chest CT,” said Fred Hutch pulmonologist and cancer prevention researcher Matthew Triplette, MD, MPH, in a recent video interview. “And that benefit’s larger than other screening modalities like mammography for breast cancer or fecal testing and colonoscopy for colon cancer screening. The mortality reduction is somewhere on the order of a 20% to 26% reduction in lung cancer mortality — that data’s based on clinical trials.”

Unfortunately, these results were hard to achieve in the real world.

According to the American Lung Association, the lung cancer screening rate for those at high risk is just 5.7%; the National Cancer Institute puts preventive screenings for breast, colon and cervical cancers at 70% and higher.

“There are two main issues which I consider big leaks in the pipeline for people successfully engaging in lung cancer screening,” Triplette said. “One is that only 10% to 15% of all eligible people in the U.S. — that’s about 16 million people — have gotten a lung cancer screening. Even one. We’re not doing a great job in terms of uptake, finding the patients who are eligible and helping them get screened. The second issue is that once people are engaged in screening, we’re seeing a lot of drop-out in terms of people not following up with their next steps.”

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No follow-up for many with positive findings

In a recent study, published in the Annals of American Thoracic Society, Triplette and colleagues from the University of Washington School of Medicine and the Veterans Affairs Puget Sound Health Care System analyzed lung cancer screening data from patients screened at multiple sites including Harborview’s safety net clinics, UW Medicine clinics and Fred Hutch.

A total of 369 patients had positive findings on their low-dose CT scans, with 16% of those findings ultimately diagnosed as lung cancer. But nearly half of those diagnoses were delayed, some by a month or two, others by more than half a year.

“Not many people have talked about what happens to the patients who have a positive finding [on a lung cancer screening],” Triplette said. “The assumption is that they’re going to do something about it. We actually questioned that and found half of patients with positive findings had delays in follow-up care.”

Triplette called that “in and of itself concerning,” but when he and colleagues took the study a step further, they discovered something even more disturbing.

“We found a significant number of patients had clinical upstaging of their lung cancers by the time they eventually followed up,” he said. As with many other cancers, lung cancer’s stage at diagnosis is directly tied to prognosis, treatment options, and ultimately, survival.

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