PURPOSE: Large scale clinical trials are underway in the United States and Europe to evaluate the efficacy of lung cancer screening. The objective of this study is to examine physicians’ attitudes and beliefs towards screening for lung cancer.
METHODS: This prospective, descriptive survey was developed by the investigators using items from validated instruments on cancer screening (n=14) while others were developed de novo (n=8) by the research team. A total of 3000 physicians (1000 family practitioners, 1000 internists, and 1000 pulmonologists) were mailed the survey, with 2 follow-up mailings for non-responders. Based on their response, physicians were categorized using a five point response scale as high screeners (HS=very often/always), low screeners (LS=rarely/sometimes), or no-screeners. Additionally, physicians were asked to rank in order factors that would influence screening.
RESULTS: A total of 303 physicians completed the survey, including 215 (71%) primary care providers and 88 (29%) pulmonologists. Twenty five percent report that they actively screen smokers for lung cancer with chest radiography. Pulmonary physicians screen more often than primary practitioners (HS 49% vs. 16%, p=0.02). Physicians with 0–5 years after training screen less compared to those with >10 years in practice (HS 0 vs. 28%, p=0.0075). University affiliation was not associated with differences in screening preferences (p=0.25). The factors that are important for physicians when assessing a screening program are (from most to least important): (1) clinical efficacy (2) ACS/USPSTF guidelines (3) randomized, controlled trials showing mortality benefits (4) low number of false-positive test results (5) cost-effectiveness to society.
CONCLUSION: Despite the fact that chest radiographic screening is not recommended, a substantial group of physicians screen anyway. Pulmonologists screen more often than primary care providers. Clinicians with more years in practice screen more often than those without.
CLINICAL IMPLICATIONS: Screening outside accepted guidelines has potential risks including false-positive results, unnecessary invasive procedures, radiation exposure, psychological stress, and increased costs to the health care system. Further study is needed to explore reasons for this practice.
DISCLOSURE: Mario Gomez, None.