Tool helps patients, providers decide if lung cancer screening is warranted

A 65-year-old male smoker with a history of 2 packs a day for 45 years with no personal or family history of cancer wonders: Should I be screened for lung cancer?

A new web-based app developed at the University of Michigan School of Public Health, and endorsed by the American College of Radiology, can provide answers.

The free screening tool, which also considers this patient's weight of 220 lbs. and height of 5'11", as well as other information, calculates his chance for developing lung cancer over the next six years and concludes he is eligible for a CT scan to screen for the disease according to criteria established by the U.S. Preventative Services Task Force.

The tool provides the kind of information individuals need to have good discussions with their doctors about whether CT screening is a next step.

In an article in the current issue of the American Journal of Preventive Medicine, researchers detail results of a small study that showed shouldiscreen.com is effective at improving patient knowledge about lung cancer and screening. It also helped patients decide if CT screening was the right choice for their situations.

"Shared-decision making is significant because we want patients to be active participants in their health," said Rafael Meza, assistant professor of epidemiology and lead developer of the tool. "Of course, knowing the risk is only one part of the story. The individual and his or her physician will still need to decide whether or not to go through with it, taking into account personal values and preferences. This is a personal decision."

The study involved 60 participants who were asked questions before and after using the web tool. They were current or former smokers who had no history of lung cancer and had not undergone any chest CT in the past year. Eighteen percent were found to be eligible for CT screening for lung cancer.

The tool tells patients why screening is suggested, who should be using this method for lung cancer early detection and what actually happens during a CT. It also has information about radiation exposures, one of the big considerations patients must weigh about CT screening, and offers them help with smoking cessation.

CT screening is not recommended for never smokers, and not even for all smokers, Meza said. It is not completely harmless, as more diagnostic tests could be needed following a positive screen and those could involve invasive procedures, he said.

"We hope that by providing them with an individualized estimate for lung cancer, along with the associated risks of screening, they will be able to make a more informed decision," said Yan Kwan (Lisa) Lau, doctoral student in epidemiology who led the study.

Lau said one limitation of the study is that it was conducted before CT screening became a funded procedure by The Centers for Medicare and Medicaid Services and some private insurers, something that happened less than a year ago. So while it was helpful in conveying information and identifying candidates for CT screening, the team will have to conduct further studies to determine which patients actually follow through and get screened.