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Original Investigation
Less Is More
April 13, 2020

Assessment of Lung Cancer Screening Program Websites

Author Affiliations
  • 1Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill
  • 2Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill
  • 3Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
  • 4Department of Family Medicine, University of North Carolina at Chapel Hill
JAMA Intern Med. 2020;180(6):824-830. doi:10.1001/jamainternmed.2020.0111
Key Points

Question  How do lung cancer screening program websites portray benefits and harms, and what next steps do they recommend for individuals considering screening?

Findings  In this cross-sectional study of 162 lung cancer screening program websites, potential benefits of screening were presented significantly more often than potential harms (98% vs 48%). In addition, only 22% of the websites guided individuals to a shared decision-making visit with a health care professional.

Meaning  There appears to be an imbalance in the presentation of benefits and harms on lung cancer screening program websites and a lack of guideline-driven recommended next steps for shared decision-making.

Abstract

Importance  The US Preventive Services Task Force recommends that individuals at high risk for lung cancer consider benefits and harms before pursuing lung cancer screening. Medical centers develop websites for their lung cancer screening programs, but to date little is known about the websites’ portrayal of benefits and harms or what next steps they recommend for individuals considering screening.

Objective  To assess the presentation of potential benefits and harms and recommended next steps on lung cancer screening program websites.

Design, Setting, and Participants  Cross-sectional content analysis of 162 lung cancer screening program websites of academic medical centers (n = 81) and state-matched community medical centers (n = 81) that were randomly selected from American College of Radiology lung cancer screening–designated centers was conducted. The study was performed from December 1, 2018, to January 31, 2019.

Main Outcomes and Measures  Website presentation of screening-associated benefits and harms was the primary outcome. Benefit was defined as any description related to the potential reduction in lung cancer mortality. Harms were based on the US Preventive Services Task Force recommendations and included false positives, false negatives, overdiagnosis, radiation exposure, and incidental findings. The secondary outcome was next steps that are recommended by websites.

Results  Overall, the 162 lung cancer screening program websites described the potential benefits more frequently than they described any potential harms (159 [98%] vs 78 [48%], P < .01). False-positive findings were the most frequently reported (72 [44%]) potential harm. Community centers were less likely than academic centers to report any potential harm (32 [40%] vs 46 [57%], P = .03), potential harm from radiation (20 [25%] vs 35 [43%], P = .01), and overdiagnosis (0% vs 11 [14%], P < .01). One hundred nineteen websites (73%) did not explicitly recommend that individuals personally consider the potential benefits and harms of screening; community centers were less likely than academic centers to give this recommendation (15 [19%] vs 28 [35%], P = .02). Most institutions (157 [97%]) listed follow-up steps for screening, but few institutions (35 [22%]) recommended that individuals discuss benefits and harms with a health care professional.

Conclusions and Relevance  Information on public-facing websites of US lung cancer screening programs appears to lack balance with respect to portrayal of potential benefits and harms of screening. Important harms, such as overdiagnosis, were commonly ignored in the sites evaluated, and most of the centers did not explicitly guide individuals toward a guideline-recommended, shared decision-making discussion of harms and benefits.

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    1 Comment for this article
    As for all human's activities
    Alain RAUSS, Medical Doctor | Public Health
    As always with screenings, the harmful effects are far less presented than the benefits.
    Beyond this rather "usual" observation in relation to screening, it seems interesting to question the actions of the medical profession.  The profession does not, once again, always and only focus on the health of populations, but does not fully present the disadvantages of screening because of the business interests. What is ultimately shocking in this finding is that many believe that the health sector "could", "should" be provided sanctuary in relation to business, and that this is not the case.
    CONFLICT OF INTEREST: None Reported
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