|
 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.
[to top of second column] |
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: http://bit.ly/2Fqh8Mt JAMA Internal Medicine, online January
14, 2019.
[© 2019 Thomson Reuters. All rights
reserved.] Copyright 2019 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content.
 |
