Complication rates following invasive diagnostic procedures for lung abnormalities were twice as high in the community setting compared to those reported in lung cancer screening trials, and associated downstream costs ranged from $6,320 to $56,845 on average, according to a new study from The University of Texas MD Anderson Cancer Center.

The researchers believe the findings, published today in JAMA Internal Medicine, reinforce the need for including these risks in the shared decision-making communication between patients and physicians when considering lung cancer screening for high-risk individuals.

Lung cancer is the second most common cancer in both men and women, and the leading cause of cancer death in the U.S. As most patients with lung cancer are diagnosed at advanced stages, effective early screening strategies for lung cancer are a major public health priority, explained Ya Chen Tina Shih, Ph.D., professor of Health Services Research and corresponding author on the study.
In 2011, the National Lung Screening Trial (NLST) demonstrated that lung cancer screening by low-dose computed tomography (LDCT) in high-risk individuals achieved approximately a 16 percent reduction in lung cancer mortality. Based on this study, the U.S. Preventive Services Task Force recommends certain current and former smokers ages 55-80 undergo annual LDCT screening for lung cancer.

“When looking at the results of the NLST trial, many have concerns about false positives, which put patients at risk with invasive diagnostic procedures,” said Shih. “We felt that downstream complication rates reported in this trial might be underestimated because it was conducted in a well-controlled environment. For screenings conducted in real-world practices, where patients are not subject to clinical trial protocols, we might see even higher complication rates from invasive procedures.”

The NLST reported false-positives in nearly one-quarter of participants, meaning the test found cancer when there was none. Reported complication rates for invasive diagnostic procedures, which included cytology/needle biopsies, bronchoscopies or thoracic surgeries, were under 10 percent.

Indirect approach to estimate real-world costs and complications

To investigate complication rates following similar procedures outside of the clinical-trial setting, the researchers analyzed claims data from the MarketScan database between 2008 and 2013. Unfortunately, these data do not indicate if an individual had LDCT screening because the relevant billing code was established in February 2015, so researchers analyzed claims for those who had similar procedures for lung abnormalities as those reported in the NLST.

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