by
Lisa Chamoff, Contributing Reporter | December 16, 2013
Kazerooni said a big reason for overdiagnosis in the years-long NLST was that lung nodules of 4 to 5 millimeters triggered positive results, but further study has shown that even if the size threshold is raised, CT screens will still miss very few cancers and overdiagnosis will decrease.
"We know more today about what we don't have to biopsy and what we don't have to manage aggressively," Kazerooni said.
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The Journal of the American College of Radiology this month published "Controversies in Lung Cancer Screening," which acknowledges that there are still concerns about overdiagnosis, as well as issues such as dealing with small nodules, radiation dose and increased workflow for radiologists.
According to the JACR study, a multidisciplinary approach that includes screening to identify and assess slow-growing cancers doesn't necessarily have to include biopsy or surgical removal.
Dr. Ritu Gill, a thoracic radiologist at Brigham and Women's Hospital in Boston and the lead author of the JACR study, said there is also research being conducted that could eventually lead to pre-screening -- screening a patient's urine for lung cancer biomarkers, for example — and that would limit CTs to those who are more at risk, thereby limiting overdiagnosis.
"It is important to identify the correct population to be screened," Gill said. "If we can get better at it, we can bring down overdiagnosis."
The JACR study also recommends launching extensive education and training programs led by large academic centers to help radiologists in community practices deal with the new workload, having standardized, structured reporting for lung cancer screenings and creating educational materials to help patients and their doctors manage their concerns if no follow-up is recommended when screenings detect small, stable nodules.
For Kazerooni, the fact remains that CT has emerged as a viable way to screen for the No. 1 cause of cancer deaths in the U.S.
"CT, we know, reduces mortality, and we know it does it more effectively," Kazerooni said. "That's in the face of whatever overdiagnosis is happening."
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