Lung cancer screening could save thousands, study suggests

By Sally Robertson, B.Sc.Sep 11 2014

Experts from the Centers of Medicare and Medicaid Services (CMS) have weighed up the pros and cons of lung cancer screening to determine whether Medicare-eligible individuals would actually benefit from annual testing.

Findings from the National Lung Screening Trial (NLST) initiated in 2011 have already shown that low-dose computed tomography (LDCT) screening of people aged 55 to 74 significantly reduces their risk of dying from lung cancer due to heavy smoking.

This led to the U.S Preventive Services Task Force recommending annual LDCT screening for those aged 55 to 80 who had smoked one packet of cigarettes a day for 30 years or two packets a day for 15 years.

However, some analysts have questioned whether the screening would really be of benefit to the Medicare-aged population, as only 25% of the NLST participants were aged 65 or older.

To determine the best practice for these individuals, CMS researchers carried out further analysis of the NLST data, comparing the results for those aged 65 and older with the results for those aged under 65.

As reported in the Annals of Internal Medicine, researchers form the National Cancer Institute Paul Pinsky and colleagues found that to prevent one lung cancer death, 245 participants form the older cohort needed to be screened, compared with 364 from the younger cohort.

The rate of false-positive screening was slightly higher in the older versus younger cohort, but both the prevalence of cancer and the positive predictive value of screening were higher for the older cohort.

Furthermore, analysis of the participants’ overall survival showed that 64% of those aged 55 to 64 lived for five years, compared with 60% of those aged 65 to 69 and 50% of those aged 70 or older.

In an accompanying editorial, Dr. Michael Gould of Kaiser Permanente Southern California says that the findings provide reassurance that screening seems to involve similar trade-offs for older and middle-aged groups.

Until there is new and direct evidence to the contrary, it does not seem reasonable to exclude persons aged 65 to 74 years from access to screening,” he writes.

In the UK, leading cancer expert John Field from Liverpool University says that delaying the introduction of lung cancer screening could cost thousand of lives and that plans should be initiated now to ensure nationwide screening of older smokers by the end of 2016.