Family doctors don?t always give smokers lung cancer tests

Many family physicians don’t believe lung cancer screening can reduce deaths from these tumors, and some of them don’t offer tests even to longtime smokers, a U.S. survey suggests.
Nearly all family doctors agree that early cancer detection is more likely with low-dose computed tomography (CT) scans taken in a machine that rotates around the body to capture several cross-sectional images of the lungs than with traditional two-dimensional x-rays.
But only 41 per cent of them believe low-dose CT scans for people without symptoms of lung cancer can reduce deaths from these malignancies, the survey found.
Even for a 60-year-old patient with a long history of smoking, 12 percent of family physicians said they would not recommend any screening and another 9 percent said they would suggest only an x-ray.
“Screening is different than diagnostic testing,” noted study author Jan Eberth, a public health researcher at the University of South Carolina in Columbia.
“If a person has symptoms indicative of lung cancer, they should inform their primary care provider and see a pulmonologist as soon as possible,” Eberth added by email. “A higher dose CT scan may be needed to test for lung cancer.”
Some primary care doctors may not order CT scans to look for lung cancer in patients without symptoms because the American Academy of Family Physicians has said there isn’t enough evidence yet to recommend or discourage these tests, Eberth and colleagues note in the journal Cancer.
But the government-backed U.S. Preventive Services Task Force (USPSTF), along with the Centers for Medicare and Medicaid services and “multiple professional societies and organizations,” do support the use of CT scans for high-risk patients including some current and former smokers, the authors note.
To understand how family doctors approach screening, researchers analyzed data from surveys completed by 101 physicians in South Carolina in 2015.
Most of these doctors were white, male and had graduated from medical school at least a decade ago.
When asked about the risks of low-dose CT scans, 88 percent of family physicians expressed concern about unnecessary diagnostic procedures, and about half said they worried about exposing patients to stress and anxiety or radiation.
About half of family physicians said they would screen a 70-year-old former smoker who quit more than 20 years ago – a situation when groups like the USPSTF and Medicare recommend against it.
In another situation where screening isn’t recommended – a 50-year-old nonsmoker with 30 years married to a smoker – 22 percent of family physicians said they would offer screening.
The survey was started in 2015 before Medicare, the U.S. health program for the elderly, changed its payment polices to cover CT scans for lung cancer screening and counseling sessions discuss test with patients, Eberth noted.
One limitation of the survey was that researchers changed it later in the year to follow up with participants and ask about how Medicare coverage might influence screening decisions, the authors note.
“Primary care physicians may be overwhelmed with the amount of new information required to understand the data regarding lung cancer screening, potential benefits, and with discussing risks,” Dr. Ticiana Leal, a researcher at the University of Wisconsin School of Medicine and Public Health who wasn’t involved in the study, said by email.
People who are aged 55 to 74 and smoked two packs a day for 15 years or one pack a day for 30 years should discuss CT scans with their primary care provider, said Dr. Vinay Prasad, a researcher at Oregon Health and Science University who wasn’t involved in the study. This is particularly true of they are current smokers, or quit less than 15 years ago.
“Chest x-rays for screening is a failed strategy,” Prasad said by email.
“Low-dose CT screening for lung cancer showed a strong benefit in one randomized trial, though there are a number of caveats and nuances there that may give one pause,” Prasad added. “At a minimum, the potential benefits and potential limitations should be discussed with appropriate patients as part of shared decision making.”
Via Lisa Rapaport