Complication rates following invasive diagnostic procedures for lung abnormalities in lung cancer screening trials, and associated downstream costs from $ 6,320 to $ 56,845 on average, according to the University of Texas MD Anderson Cancer Center.

The researchers believe the findings, published today in  JAMA Internal Medicine , reinforce the need for 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 US As MOST Patients With lung cancer are diagnosed at advanced stages, effective early screening strategies for lung cancer are a major public 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 16 percent reduction in lung cancer mortality.

Based on this study, the US 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.

"Researcher felt that downstream complication rates reported in this trial might have been 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% .

Real-World Costs And Impacts

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

The study included 174,702 individuals ages 55-77 who had invasive diagnostic procedures and a matched-control group of 169,808 individuals who did not have these procedures to determine a baseline level for complication rates.

"They wanted to understand what the real-world costs are and that they probably occur after abnormal results from LDCT screening," said Shih. "Although we were not able to examine the linear path from LDCT screening to invasive diagnostics, the incremental approach applied in our study gives us an estimate of downstream adverse events for these types of procedures in the community setting."