Comparison of observed harms and expected mortality benefit for persons in the Veterans Health
al., 2017), showing a very high false-positive rate associated with lung cancer screening. The false-positive rate in that population was around 58 percent, which was more than twice the false-positive rate seen in the National Lung Screening Trial (National Cancer Center, 2014).
The U.S. Preventive Services Task Force recommends lung cancer screening with low-dose CT for high-risk people between the ages of 55 and 80, defined as having a greater than 30 pack-year cumulative smoking history and having quit within the past 15 years for those no longer smoking (grade B recommendation). In an editorial published with the current VA study, it was observed that the future oflung cancer screening “depends on our ability to reexamine and refine our approach to patient selection and clearly communicate risks and benefits of screening” (Incze & Redberg, 2018). The study cohort consisted of 2,106 veterans screened for lung cancer at eight academic VA centers during a 3-month period in the spring of 2015 as part of the Veterans Health Affairs Lung Cancer Screening Demonstration Project.
Annual baseline lung cancer mortality risk was estimated using the Bach risk model, which is a validated tool calculating sex, smoking duration, duration of abstinence from smoking, and number of cigarettes smoked per day to estimate lung cancer risk. Participants were separated into risk quintiles and assessed for lung cancer cases observed, number needed to screen (NNS) per lung cancer death prevented, and number of false-positive results and downstream diagnostic procedures. The research found “that even given these very high false-positive rates, the overall balance of pros and cons among patients at high lung cancer risk still surpassed those of most established cancer screening programs” (Caverly et al., 2018).
Caverly, T.J., Fagerlin, A., & Wiener, R.S. (2018, January 22). Comparison of observed harms and expected mortality benefit for persons in the Veterans Health Affairs Lung Cancer Screening Demonstration Project. JAMA Internal Medicine. Retrieved from https://jamanetwork.com/joumals/jamainternalmedicine/article- abstract/2599437?redirect=true
Kinsinger, L.S. , Anderson C., Kim, J., Larson, M., King, H.A., Rice, K.L.Jackson, G.L. (2017, March 1). Implementation of lung cancer screening in the Veterans Health Administration. JAMA Internal Medicine, 1 77(3), 399-406.
Incze, M., & Redberg, R. F. (2018, January 22). Editorial: Reducing harms in lung cancer screening- Bach to the future. JAMA Internal Medicine. Retrieved from https://app.jamanetwork. com/#page=issuesContainer
Memorial Sloan Kettering Cancer Center (MSKCC). (2018). Lung cancer screening decision tool. New York, NY: MSKCC. Retrieved from https://www.mskcc.org/cancer care/types/lung/screening/lung-screening-decision-tool
National Cancer Center (NCI). (2014). National lung screening trial. Washington, DC: U.S. Department of Health and Human Services, National Institutes of Health NCI. Retrieved from https://www.cancer.gov/types/lung/research/nlst