Lung cancer screening (LCS) using radiological imaging (ie, low dose computed tomography scan [LDCT])
offers a great opportunity to decrease death from lung cancer through early diagnosis. However, the clinical decision of screening is not straightforward since it should be tailored based on each patient’s risk for developing lung cancer and the expected benefits from early diagnosis. Studies have shown that lung-related
comorbidities may influence a practitioner’s perception of lung cancer screening.

To discern the weight of this influence, Eman M. Metwally, MD, PhD, MPS, and colleagues published a study in JAMA Network Open comparing the characteristics of individuals undergoing LCS and LCS results (Ie, cancer detection rate and false positive rate) among patients with and without lung-related comorbidities. Dr. Metwally recently spoke with Physician’s Weekly about the importance of this study and its impact on everyday practice.

Why did you feel this topic needed exploration? 

Lung cancer screening using LDCT is an effective intervention to decrease lung cancer death through early detection when surgical treatment is available. To date, the lung cancer screening randomized trials enrolled relatively healthy individuals with fewer comorbidities compared with individuals eligible for lung cancer screening in real-world settings.

Lung-related comorbidities (including chronic obstructive pulmonary disease [COPD]) are common among patients with lung cancer. In the context of lung cancer screening, COPD represents a double-edged sword as it is associated with an increased risk for lung cancer; however, individuals with severe COPD are at increased risk for complications related to diagnostic procedures for the evaluation of a suspicious screening finding.

However, the impact of lung-related comorbidities on lung cancer screening outcomes in real-world populations is not known. We felt this study was important to examine real-world evidence about outcomes of lung cancer screening (positive radiological findings, cancer detection rate, and false positive rate) among individuals with and without lung-related comorbidities.

What are the most important findings from your study for physicians, particularly pulmonologists, to understand?

We found that more than half of the individuals undergoing lung cancer screening have lung-related comorbidities. These patients were more likely to be female and White with a lower educational level. Lung cancer screening outcomes regarding cancer detection rates and false positive rates were similar among individuals with lung-related comorbidities versus those without lung-related comorbidities. More than 75% of lung cancers diagnosed were stage 1 non-small cell lung cancer.

What are your recommendations for physicians, particularly pulmonologists?

› Clinicians should consider the diagnosis of lung-related comorbidities, especially the severity of the disease among candidates for lung cancer screening, to balance the harms and benefits of lung cancer screening.
› During shared decision-making, clinicians should balance the increased risk for developing lung cancer among patients with COPD against the risk for increased complications related to diagnostic and treatment procedures in individuals with more advanced COPD.

Dr. Metwally and colleagues conclude that future explorations of this topic are needed and should use a larger pool of participants to examine the association between comorbidities and LCS outcomes. Measures to assess the severity of lung comorbidities to incorporate them into screening decisions should also be developed.