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Research Letter
Less Is More
March 2018

Comparison of Observed Harms and Expected Mortality Benefit for Persons in the Veterans Health Affairs Lung Cancer Screening Demonstration Project

Author Affiliations
  • 1VA Center for Clinical Management Research, Ann Arbor, Michigan
  • 2University of Michigan Medical School, Ann Arbor
  • 3Institute for Health Policy Innovation, University of Michigan, Ann Arbor
  • 4VA Salt Lake City Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, Utah
  • 5University of Utah School of Medicine, Salt Lake City
  • 6Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts
  • 7Boston University School of Medicine, Boston, Massachusetts
  • 8VA Portland Health Care System Center to Improve Veteran Involvement in Care, Portland, Oregon
  • 9Oregon Health & Science University School of Medicine, Portland
  • 10Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson Veterans Affairs Hospital, Charleston, South Carolina
  • 11Medical University of South Carolina, Medicine, Charleston
JAMA Intern Med. 2018;178(3):426-428. doi:10.1001/jamainternmed.2017.8170

The Veterans Health Affairs (VHA) lung cancer screening (LCS) demonstration project identified a much higher false-positive rate following initial low-dose computed tomographic screening than did the National Lung Screening Trial (58.2% vs 26.3%).1,2 Most false-positive results (nodules not confirmed to be lung cancer [LC] after follow-up) resulted in repeated imaging, but 2.0% of people screened also required nonbeneficial downstream diagnostic evaluation to determine these nodules were not cancer.2 We sought to put these findings into context by examining how this high false-positive rate influences the harm-to-benefit ratio for higher- vs lower-risk patients.