medwireNews: Real-world lung cancer screening (LCS) rates are generally much lower than those reported in randomized controlled trials, particularly when shorter screening intervals are used, US study findings indicate.
Robert Volk (The University of Texas MD Anderson Cancer Center, Houston) and co-investigators also found that screening rates were lower in current smokers, people from non-White populations, those younger than 65 years, and those with lower levels of education.
They therefore suggest that “[i]nterventions should be directed toward increasing LCS adherence among [these] key groups.”
The systematic review and meta-analysis included data for 16,863 individuals from 10 retrospective and five prospective cohort studies.
During follow-up periods that ranged from 12 to 36 months, the pooled LCS adherence rate across all studies was 55%, with rates in individual studies ranging from 12% to 91%.
The pooled LCS adherence rate was 30% in four studies that reported screening adherence 12 months after baseline scan, 70% in six studies that reported adherence at 15 months, and 68% in two studies that reported adherence at 18 months. One study reported an adherence rate of 38% at 24 months and 28% at 36 months.
Writing in JAMA Network Open, Volk and co-authors note that all of these rates are lower than those reported in the randomized US National Lung Screening Trial (NLST) and the Dutch–Belgian NELSON trial, at more than 95% and over 90%, respectively.
The researchers also investigated patient characteristics associated with adherence rates and found that current smokers were a significant 30% less likely to adhere to LCS than former smokers.
Conversely, White patients were twice as likely as non-White patients to adhere to LCS, people with 4 or more years of college education were 50% more likely to adhere to LCS than those who did not complete college, and people age 65 to 73 years of age were 40% more likely to adhere to LCS than those aged 50 to 64 years, with all differences statistically significant.
Volk et al conclude: “Extending the recommended interval between lung cancer screenings has the potential to increase screening adherence, reduce false-positive test results, and decrease screening costs.”
The add: “Future research should investigate the optimal screening interval that balances the harm-benefit tradeoffs of LCS.”
The investigators also note that despite “concern that screening rates nationally are low, equally important is the need for interventions to improve adherence to screening for current smokers and smokers from minority populations to fully realize the benefits of early detection of lung cancer.”
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JAMA Netw Open 2020; 3: e2025102