Lung cancer screening complications may be higher than expected

(Reuters Health) – Invasive follow-up tests to examine abnormalities found with lung cancer screening may lead to more complications and extra healthcare costs than doctors previously thought, a U.S. study suggests.

Many doctors advise older adults who are current or former smokers to get annual lung cancer screening with low-dose computed tomography (LDCT) based on a pivotal 2011 trial reporting 20 percent lower lung cancer mortality rates than when screening was done with chest x-rays. With LDCT, however, more than one in four patients get so-called false-positive results, when they’re told they have potentially malignant abnormalities that turn out to be benign.

For the current study, researchers examined nationwide data on 344,510 patients, ages 55 to 77, who had invasive diagnostic procedures to look for lung cancer between 2008 and 2013.

Overall, about 22 percent of patients under 65 in the study had complications, as did almost 24 percent of the older people in the study. These complication rates are more than twice as high as those reported in the pivotal 2011 LDCT lung cancer screening study responsible for current screening recommendations, researchers report in JAMA Internal Medicine.

“Although the screening itself may carry minimal risk, the downstream events can be harmful,” said senior study author Ya-Chen Tina Shih of the University of Texas MD Anderson Cancer Center in Houston.

“It is difficult to pinpoint what causes complications after these invasive procedures because they include a large list of conditions, and also invasive procedures include a wide variety of diagnostic procedures from needle biopsy to thoracic surgery,” Shih said by email.

Complication rates in the study ranged from about 19 percent after needle biopsies to as high as 52 percent after surgery.

Costs of these complications ranged from an average of $6,320 to $56,845 and varied by severity, patient age, and type of follow-up procedure.

The study wasn’t designed to prove whether or how invasive tests after screening cause complications or increase costs. The study also relied on insurance claims data, not medical records, and it’s possible this may have underestimated minor complications, the authors note.

Another drawback of the study is that it didn’t distinguish between patients with and without symptoms, said Dr. Hossein Borghaei of Fox Chase Cancer Center in Philadelphia.

“A symptomatic patient who undergoes a procedure for a diagnostic purpose is different and could have more complications compared to an individual (without symptoms) who is being screened for this disease,” Borghaei, who wasn’t involved in the study, said by email.

Even so, the results offer fresh evidence that the pivotal 2011 lung cancer trial done at academic medical centers may not reflect outcomes at community hospitals where many patients get care, said Dr. Dan Reuland of the University of North Carolina at Chapel Hill School of Medicine.

“Complications from invasive chest procedures could actually happen more frequently in community practice,” Reuland, who wasn’t involved in the study, said by email.

With the potential for complications after follow-up tests, patients should consider whether they are among those most likely to benefit from screening, said Dr. Mark Ebell, a researcher at the University of Georgia in Athens who wasn’t involved in the study.

“The patients most likely to experience a net benefit are those 60 to 69 years who are current smokers,” Ebell said by email. “Older patients often have more health problems that limit their ability to benefit from screening, and those who have quit smoking 5 to 10 years ago are at significantly lower risk.”

SOURCE: JAMA Internal Medicine, online January 14, 2019.

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