Current research data shows that awareness of lung cancer screening remains low

There is a lung cancer screening test that saves lives – and yet most people who could get the test have never heard of it or talked to a doctor about it.

“We have a screening test that works. It works just as well, if not better, than screening for breast and colorectal cancer when it comes to reducing mortality. It’s one of the most life-saving things we have for a cancer that kills more people. than either of these two together,” says lung cancer pulmonologist Gerard Silvestri, MD

And yet, he said, “Eighty percent of those eligible for this screening, regardless of race, education, ethnicity, health or income, had never heard of lung cancer screening or discussed it with a doctor.”

Silvestri is the lead author of a new publication from a group of researchers at MUSC Hollings Cancer Center investigating awareness of the existence of lung cancer screening. The paper was published in this week JAMA network opened.

Lung cancer screening consists of a low-dose CT scan of the lungs. It is a non-invasive, painless test and does not require anesthesia. The scan can detect lung cancer in its early stages, which can often be completely removed with surgery. Importantly, eligible patients should have a scan every year so doctors can look for changes.

Nationwide, less than a fifth of those eligible for the test receive the test.

“Overall, lung cancer screening participation is somewhere between 16% and 20% — and that’s an optimistic estimate,” Silvestri said.

Cancer disparities researcher and first author Kalyani Sonawane, Ph.D., said the group wanted to get a better sense of how many people have heard of lung cancer screening.

“Lung cancer screening has been recommended for some time, but uptake is extremely low,” she said. “When we think about screening, the most fundamental thing you expect is that there is some form of communication that the screening exists. So we need to have knowledge and awareness among the population and, as with other preventive interventions, it is also partly the responsibility of health care providers to communicate.”

The group used data from an ongoing National Cancer Institute survey that asked about people’s knowledge and perceptions about cancer and other health issues.

Of those who used to smoke cigarettes, 18% had never heard of lung cancer screening and 75% had never talked to a doctor about it. Of those who currently smoke cigarettes, 14% had never heard of lung cancer screening and 71% had never talked to a doctor about it.

Sonawane pointed out that because of the way the survey question was worded, people had to choose one answer. It’s possible that some people who had never talked to a doctor about it had never heard of the test either. An earlier American Lung Association survey that asked similar questions found that 73% of people had never talked about their lung cancer risk. a doctor and 62% were not familiar with lung cancer screening.

“I wish I could say I was surprised by these findings, but I don’t think screening for lung cancer is as popular as screening for colon cancer,” said Benjamin Toll, Ph.D., co-director of the Division of Lung Cancer. cancer screening program at MUSC, director of the MUSC Health Tobacco Treatment Program and co-author of the article.

“I think it would be great if we could encourage our doctors, especially our primary care physicians, to promote this as a screening method, especially for current smokers,” he said.

Increasing the number of conversations about lung cancer screening during primary care visits offers opportunities, but the researchers also recognized the burden already on primary care physicians.

“Our primary care physicians have so many screening tests and so much to do that it’s hard to prioritize what to do when. There’s a long list and they probably have 20 minutes. It’s really a challenge to get it all done,” Toll said . .

In addition, the group of people who are eligible for this screening test is also a particularly difficult group to reach, according to Silvestri.

“Smoking in itself is a sign of inequality,” he said. Research shows that people who smoke tend to have lower incomes, live in rural areas, have less education, and are less likely to have a primary care provider. All this makes this group more difficult to reach.

There may also be some fear with the test that doesn’t necessarily exist with tests for other types of cancer.

“I found in my own patients who I have helped quit smoking that there is a stigma because they worry that they have ‘given themselves lung cancer,’” Toll said. “I don’t entirely agree that the patients ‘gave themselves lung cancer’ because the tobacco companies spent decades treating their cigarettes to make them more addictive; so in my opinion they made part of the choice from the end. ” user.”

Silvestri said many groups are working to include lung cancer screening reminders in electronic health records, but making this operational is more challenging than adding reminders for other types of screening.

For example, colon cancer screening reminders only require the patient’s date of birth because these screenings are recommended for everyone age 45 and over.

However, lung cancer screening depends on a combination of age and ‘pack years’, which are calculated based on the number of packs per day a person smokes, and this detailed information is often not contained in the electronic health record. Silvestri said the MUSC screening program is working with the electronic health record vendor to improve the specificity of the information in the record.

But even without that information, MUSC has steadily expanded its lung cancer screening program.

“We’re screening more people across the state, and we’re excited about that,” Silvestri said. “We find a diagnosis rate of 3.3%. More importantly, most of these are in the early stages, so they have a high chance of cure.”