RSNA13: Radiologists ready to screen for lung cancer--and do it cost effectively

Radiologists are ready to screen for lung cancer, and do it cost effectively, according to Caroline Chiles, M.D., a radiologist at the Wake Forest University Health Sciences Center, who spoke Wednesday during a controversy session at the annual meeting of the Radiological Society of North America in Chicago.

Chiles (pictured) was a principal investigator in the National Lung Screening Trial (NLST) that ultimately concluded that participants who received low-dose helical CT scans had a 20 percent lower risk of dying from lung cancer than participants who received standard chest X-rays.

There has been much debate about the value of lung cancer screening in recent years, even since the NLST results were published, but now that the United States Preventive Services Task Force has issued a draft recommendation supporting annual screening with low-dose CT for people at high risk of developing lung cancer, chances are that screening will become more widespread.

As a chest radiologist, Chiles said that it's hard "not to focus on the grim lung cancer statistics," pointing out that there are about one-quarter of a million new lung cancer cases each year, and that an estimated 160,000 Americans died from the disease last year.

The problem with treating lung cancer, she said, is that many patients aren't diagnosed until they already have advanced stage 4 disease, where the prognosis for long-term survival is quite poor. "So the goal of lung cancer screening is to shift those patients who are presenting with stage 4 disease, to those who are presenting with localized, more curable disease," she said.

According to Chiles, estimates of the cost-effectiveness of lung cancer screening (as measured by dollars per quality-adjusted life year) vary, but aren't out of line with those of mammography. "So if you think mammography is worth doing, then I think you have to say lung cancer screening is worth it, too," she said.

Still, there are things that should be done to make lung cancer screening more cost-effective, she said. For example, being able to better predict lung cancer risk will allow policy makers to make more cost effective decisions about "who should be screened and how often, and this will change the yield of screening and it's cost effectiveness."

Other things that can be done, she said, include reducing false positives by better characterizing indeterminate nodules, and reducing overdiagnosis.

"I think we' ready to screen. I think we have enough evidence to say that we can do this and be effective within a benchmark the U.S. has set for health interventions," Chiles said. "We have a number of ways to improve our cost effectiveness going forward [and] I think this is going to be a very dynamic field--one that changes every year."

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