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Many physicians don't follow guidelines about lung cancer screening

Many primary care physicians' beliefs and recommendations about lung cancer screening are inconsistent with current evidence and guidelines, a new study led by National Cancer Institute researchers found.

The study led by Klabunde C.N. and colleagues found two-thirds of the surveyed doctors said low-dose spiral computed tomography screening is very or somewhat effective in reducing lung cancer death risk in current smokers.

The researchers said in their report that there has been no evidence from any high quality study suggesting that screening may lower lung cancer death risk and expert groups do not recommend any screening for asymptomatic individuals.

However, the authors said lung cancer screening tests are available in the United States and they suspected that primary care physicians may play a role in recommending the screening tests to patients.

The study was meant to assess primary care physicians' beliefs about lung cancer screening guidelines and the efficacy of screening tests and determine whether they would recommend for asymptomatic individuals.

Data were collected in 2006 and 2007 from 962 primary care physicians and analysed in 2009. The researchers found one quarter said the major guidelines support lung cancer screening, which in fact is not the case, and two thirds said the spiral CT is very or somewhat effective in reducing lung cancer mortality in current smokers.

The survey suggested 67 percent of the physicians would recommend lung cancer screening for asymptomatic patients with varying smoking exposure.

Most of those who recommended screening said they would use chest x-ray while up to 26 percent would use the spiral CT.

The researchers said doctors need to receive provider education regarding the evidence base and guideline content of lung cancer screening.

The findings were reported in the Nov 2010 issue of American Journal of Preventive Medicine.

Another study recently published in Radiology showed that annual spiral CT scan screening may reduce lung cancer death risk in smokers or ever-smokers, who had 30 pack-years of smoking history, by 20 percent. 

The study authored by Constantine A. Gatsonis at Brown University and colleagues and funded also by the National Cancer Institute has not been completed and more details will be released later.

It remains unknown how this study would affect the current guidelines.  The study results may not be sufficient to support lung cancer screening as potential risks from radiation were not assessed against the benefits. And high rates of false positives associated with the spiral CT, as another study found, can be another issue. 

The US Preventive Service Task Force found no sufficient evidence to support screening asymptomatic people for lung cancer and American Cancer Society does not recommend lung cancer screening either.

By David Liu

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