CHEST Guidelines-Measuring-Harms-of-Lung-Cancer-Screening

Measuring-Harms-of-Lung-Cancer-Screening_chest

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The document discusses the significance of measuring harms in lung cancer screening to improve clinical and cost-effectiveness outcomes. Two major trials, the US National Lung Screening Trial (NLST) and the Dutch-Belgian Lung Cancer Screening Trial (NELSON), showed a significant reduction in mortality but also reported substantial intervention in benign disease cases. These interventions, though largely safe, require attention to avoid unnecessary procedures in healthy participants. Notably, the benign resection rate, a metric for surgery conducted on non-cancerous findings, was high in these trials.<br /><br />In contrast, more recent screening programs, like the UK Lung Cancer Screening Trial (UKLS) and a Spanish screening study, achieved lower benign resection rates of 10% and 9%, respectively. These programs followed updated guidelines which helped refine nodule management, reducing unnecessary surgeries.<br /><br />A study by Manyak et al. highlighted the lower incidence of harms in newer lung cancer screening programs, with a benign resection rate of 12%. It emphasized the importance of addressing incidental findings which could lead to unnecessary interventions. The authors suggested the use of the Lung-RADS system to minimize invasive procedures without compromising diagnostic timing.<br /><br />The document also covers the need for comprehensive data collection in lung cancer screening to track potential harms, like stage progression during observation, time delays, and unnecessary interventions, which are crucial for the program’s success.<br /><br />Emphasizing quality assurance through data collection and analysis allows for improvements in current standards, leading to fewer unnecessary procedures and enabling shared decision-making with patients. Notably, the approach can facilitate reducing higher radiation dose imaging in screenings by improving nodule management, as shown by UKLS outcomes. This comprehensive approach to measuring harms ensures that lung cancer screening programs are both effective and safe.

Keywords

lung cancer screening

clinical outcomes

cost-effectiveness

NLST

NELSON

benign resection rate

nodule management

Lung-RADS

quality assurance

radiation dose