Uptake in Lung Cancer Screening May Depend on Modalities Provided

In a report published in Value in Health, researchers found that an uptake in lung cancer screening is likely to be more attainable if different modalities of screening are provided.¹

Low-dose computerized tomography screening can reduce lung cancer mortality by at least 20%, however this study suggested that it’s also necessary to identify which screening options tend to be more attractive in order to determine a patient’s willingness to be screened.²

“To explore Australian population preferences for lung cancer screening, we used a ranking task administered online,” author Richard Norman, PhD, professor in the School of Public Health at Curtin University in Perth, Australia, said in a press release. “Respondents were presented with 3 options: 2 hypothetical screening alternatives or ‘no screen.’ The aim of the project was to identify what aspects of low-dose computerized tomography lung cancer screening are relatively more or less attractive to individuals most likely to be targeted for screening.”

Both conditional logit and mixed logit analyses were utilized in order to evaluate both the forced choice between the 2 screens and identify the types of respondents most likely to opt out of any screening. For this, respondent 6-year lung cancer risk was estimated and used as a covariate.

Overall, respondents were found to value tests that involved breath or blood tests in addition to computerized tomography (CT), locations that were close to home, receiving results quickly, and minimizing radiation from the CT scan. Moreover, an individual’s willingness to pay was found to differ between relatively higher and lower risk individuals, with higher risk individuals placing greater emphasis on convenience, result timeliness, and radiation. 

Further, respondent characteristics that predicted opting out of any screening included being male, fewer years of smoking, and not having a previous cancer diagnosis. However, lung cancer risk was not found to influence the likelihood of opting out.

“The results of this study show if the intent is to change the uptake of lung cancer screening, then focusing on providing fast and convenient testing is an important avenue for doing so,” said Dr Norman. “Respondents at higher risk appear to be less willing to travel significant distances and less willing to spend time at the location.”

Generally, lung cancer symptoms do not appear until the disease is already at an advanced stage.³Additionally, even when lung cancer does cause symptoms, they are often mistaken for other problems, such as infection or long-term effects from smoking, further underscoring the necessity for lung cancer screening. 

The American Cancer Society (ACS) has a lung cancer screening guideline for individuals with a higher risk of developing lung cancer that is based on the National Lung Screening Trial. According to the ACS, yearly lung cancer screening with low-dose CT (LDCT) scans should be recommended for those who are 55 to 74 years old, are in fairly good health, and also meet the following criteria:

• Are current smokers or smokers who have quit in the last 15 years.

• Have at least a 30 pack-year smoking history.

• Receive counseling to stop smoking if they are still current smokers.

• Have been told by their doctors about the possible benefits, limits, and harms of screening with LDCT scans.

• Have a facility where they can go that has experience in lung cancer screening and treatment. 

References:

1. Norman R, Moorin R, Maxwell S, Robinson S, Brims F. Public Attitudes on Lung Cancer Screening and Radiation Risk: A Best-Worst Experiment. Value in Health. ispor.org/publications/journals/value-in-health/abstract/Volume-23--Issue-4/Public-Attitudes-on-Lung-Cancer-Screening-and-Radiation-Risk--A-Best-Worst-Experiment

2. Uptake of Lung Cancer Screening May Depend on Making Testing Fast and Convenient [news release]. Lawrenceville, NJ. Published April 22, 2020. newswise.com/articles/uptake-of-lung-cancer-screening-may-depend-on-making-testing-fast-and-convenient. Accessed April 27, 2020. 

3. American Cancer Society. Can Lung Cancer Be Found Early? American Cancer Society website. Published October 1, 2019. cancer.org/cancer/lung-cancer/detection-diagnosis-staging/detection.html. Accessed April 27, 2020.