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August 13, 2018

Failing Grade for Shared Decision Making for Lung Cancer Screening

Author Affiliations
  • 1Department of Medicine, Division of Cardiology, University of California, San Francisco
  • 2Editor, JAMA Internal Medicine
JAMA Intern Med. 2018;178(10):1295-1296. doi:10.1001/jamainternmed.2018.3527

As we accrue more data on the benefits and harms from cancer screening, it is clear that the benefits do not always exceed the harms. This imbalance is particularly at issue in lung cancer screening by low-dose computed tomography (LDCT), for which 1 randomized clinical trial found a mortality benefit in high-risk smokers and ex-smokers,1 but 3 other randomized clinical trials found no benefit.2-4 In addition, data from the National Health Interview Survey show that most people undergoing screening for lung cancer do not fall in the recommended groups, and thus their harms of LDCT, including radiation exposure, will likely exceed the benefits.5

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    2 Comments for this article
    Anthony Glaser, MD, PhD | Paladina Health
    Hard to believe that "Even in the highest-rated discussions, there was no mention of possible harms from the screening by the physicians, even though these harms include a 98% false-positive rate". I can understand all the time stresses and pressures primary care physicians (of which I am one) are under, but this is truly appalling. If we can't get our own house in order, why are we surprised that third-party payers require prior authorization for more and more treatments, tests, and procedures. I wonder if there have been any malpractice suits brought by the some of the 98% after they have undergone unnecessary lung biopsies. Is that what it will take to get us - or at least a few of us - to get even the barest semblance of informed consent for a 100% elective procedure?
    SDM for PSA screen
    Gerry Silverstein, PhD | University of Vermont, Emeritus faculty

    I would be interested in a similar shared decision making study with PSA testing. Based upon my own experience, the results would likely be as disappointing as with lung cancer screening.