Lung cancer is the leading cause of cancer deaths nationally and in North Carolina, with most patients diagnosed at an advanced stage when treatment is less effective. To detect the disease earlier, when it is more treatable, annual low-dose computed tomography is recommended to screen for lung cancer in high-risk patients.
But some providers are concerned that lung cancer screening may do more harm than good. For example, many patients undergo screening and receive a false positive: an abnormal lung finding that could potentially be cancerous but turns out not to be after further testing. These patients often endure additional imaging tests or invasive procedures to evaluate the abnormal finding — which carry risks of complications and could cause anxiety or financial distress.
To better understand the burdens of false-positive screenings and explore ways to mitigate them, the National Cancer Institute awarded Louise Henderson, PhD, MSPH, a $3.2 million grant to identify the potential harms of these false-positive results at the patient, clinician, and facility levels. The study’s other lead investigators are Angela Stover, PhD, associate professor of health policy and management at UNC Gillings, and Patricia Rivera, MD, formerly of UNC Lineberger and now at the University of Rochester Medical Center.
“We want to quantify the extent of this concern and see if we can identify which types of patients are more likely to experience a false positive,” said Henderson, professor of radiology and co-leader of UNC Lineberger’s cancer epidemiology research program. “This information may help to alleviate concerns or may be used in conversations between patients and clinicians when they discuss the screening process to help understand what to expect.”
Henderson said more research in lung cancer screening is needed to evaluate how well screening actually performs in real-world populations and settings, not just in clinical trials. For example, the U.S.-based National Lung Screening Trial ensured that about 95% of participants returned every year for three years for their annual scan, but across North Carolina the return rate was only about 40%.
Increasing awareness about the importance of lung cancer screening would help improve low screening participation rates, Henderson said. In North Carolina, lung cancer screening occurs in just 10% of those who are eligible compared with breast or colorectal cancer screening, which occurs in 79% and 64%, respectively. A comprehensive database showing real-world patterns and outcomes of lung cancer screening throughout the state can help illuminate this gap and track changes over time.
The N.C. Lung Screening Registry, a UNC-based statewide partnership with community and academic sites across North Carolina, contains information from more than 40,000 patients, including demographics, comorbidities, smoking history, screening results and cancer outcomes.
“We collect and analyze data on individuals screened for lung cancer across the state to address the need for evidence on how well lung screening is working and to identify gaps where we can intervene to improve care,” Henderson said. “There is such a big need for more research across the lung screening care continuum as we work to address the leading cause of cancer mortality in North Carolina.”