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Expert Calls Screening to the Forefront in Lung Cancer

Caroline Seymour
Published: Thursday, Aug 09, 2018

Robert Jotte, MD, PhD
Robert Jotte, MD, PhD
If physicians incorporated routine lung cancer screening into clinical practice, at least 40,000 lives could be saved annually, according to Robert M. Jotte, MD, PhD.

on Advanced Non–Small Cell Lung Cancer, Jotte addressed the underutilization of lung cancer screening in the United States and the importance of multidisciplinary management in improving patient outcomes.

OncLive: What should be known about screening in lung cancer?

Jotte: The NLST was a large trial that [screened] over 53,000 patients for lung cancer and followed them for lung cancer–specific outcomes with low-dose spiral CT versus chest x-ray. We found that the incidence of lung cancer detection was much greater with the low-dose CT scan.

Unfortunately, a very high percentage of diagnoses correlate with disease-specific survival and death with regard to lung cancer. If we instituted screening, we could save a tremendous number of lives in the United States alone, let alone globally. The statistics I talked about were more here in the United States. The equivalence of over 40,000 [lives] could be saved per year just by instituting screening and getting patients the operating room rather than getting them to the intravenous chemotherapy chair.

Why is there such a low rate of screening?

The reason why there is such a low rate of screening, as presented in the 2018 ASCO Annual Meeting, is a result of multiple factors. The primary reason is that the topic just isn't being brought up. I see it in my office all the time. Many primary care providers are expected to wear so many different hats. They have to take care of so many different problems, and lung cancer screening is yet another thing that has to be mentioned in a relatively brief office visit. You have to prioritize what the immediate risk to the patient is. It's sometimes hard for us to focus on those risks that are down the road.

How does shared decision-making factor into it?

There are specific criteria that we follow called the Fleischner criteria, and those criteria have recently been updated. The whole purpose of those criteria is to minimize unnecessary invasive procedures and maximize the detection rate. Therefore, if someone comes in we can identify a solitary pulmonary nodule as early lung cancer.

Radiologists will allude to those criteria in their radiology reports in terms of who needs to be worked up and who needs to be biopsied. It's a shared decision-making process that takes place between the provider and the patient so that the patients understand what all those things are.

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