Lung Cancer Screening With a Counseling and Shared Decision-Making Visit

Lung Cancer Screening: Impacts of a Counseling Visit

Background: In 2013 the American Cancer Society issued an initial guideline for lung cancer screening. These recommendations were a result of the National Cancer Institute’s National Lung Screening Trial.  The findings indicated that lung cancer screening could save lives. The guideline recommended that health care professionals should talk about screening with apparently healthy individuals between 55 and 74 years of age who have smoked at least a pack of cigarettes per day for 30 years (or equivalent) and who currently smoke or have quit in the past 15 years.  A counseling and shared decision-making visit with a health care professional has been mandated to help individuals with the decision whether to have low-dose computed tomography (CT scan) screening or not.    Study: In the March 2017 issue of the journal CHEST, Dr. Mazzone and colleagues at the Cleveland Clinic reported on their experience with lung cancer screening counseling and shared decision-making visits.  Results: A total of 423 patients had a shared decision-making visit between April 2015 and April 2016. Of these, 23 individuals, or about 5%, decided not have low-dose CT scan of the chest. Eleven of the 23 chose not to proceed with the CT scan after the discussion. Nine of the 23 did not meet the screening requirements.  Starting in November 2015, patients were asked to complete a survey about their knowledge of lung cancer screening before and immediately after the visit. Prior to the visit, most patients had a poor understanding about the required age and smoking history to be screened as well as the benefits and harms of screening. There was a significant improvement in the knowledge of patients about these requirement after the visit. Conclusions: The authors concluded that a counseling and shared decision-making visit improves the knowledge of patients about who is eligible for screening as well as benefits and possible harms of CT scan screening. My Comments: The mandated visit for lung cancer screening counseling and shared decision-making is typically available at academic medical center or large teaching hospitals. Anyone who has COPD due to smoking cigarettes has an increased risk of lung cancer.  The purpose of screening with CT scan is to find a lung cancer early with the hope that surgical treatment will remove it completely. However, if you have advanced COPD, it is likely that your lung function would be too low to tolerate possible lung surgery. If so, lung cancer screening would not make sense.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.