When CMS approved low-dose CT (LDCT) lung cancer screening for reimbursement, many health care professionals saw it as a landmark victory — but a survey by the University of South Carolina suggests many physicians still lack a solid understanding of appropriate use in lung cancer screening.

The United States Preventive Services Task Force, Medicare and various societies and organizations support the use of LDCT screening for high-risk patients. On the other hand, the American Academy of Family Physicians claims that there is not enough evidence to recommend or discourage it.

Researchers at the university sent a questionnaire to members of the South Carolina Academy of Family Physicians in 2015 and 101 of them filled it out. The results revealed that the majority of them were misinformed about the organizations that recommend screening.
Even though 98 percent agreed that LDCT screening increases the likelihood of detecting disease at earlier stages, only 14 percent believe that it reduces lung-cancer related deaths. The majority of them — 75 percent — talked with their patients about the benefits and risks of screening, but just more than half made screening recommendations in the past year.

The benefits of LDCT outweigh its potential harms for 75 percent of the respondents, but 88 percent were concerned about unnecessary procedures, 52 percent about anxiety and 50 percent about radiation exposure.

The respondents were asked if they would recommend LDCT lung cancer screening for a 60-year-old patient with a 30 pack-year smoking history. Twelve percent stated they wouldn’t and nine percent would recommend a chest X-ray instead. However, LDCT is the only screening strategy proven to be beneficial for a person with those risks.

The researchers believe that the solution is to educate the primary care physicians so they will have a foundation to base their treatment recommendations on. Decision aids might also be useful to foster treatment discussions between physicians and patients.

"With the Centers for Medicare and Medicaid Services now offering reimbursement to primary care providers to engage in shared decision-making with their patients about lung cancer screening, it is vital that providers have an accurate understanding of the eligibility criteria for screening and potential risks and benefits,” Jan Eberth of the University of South Carolina, said in a statement.

The results of the survey were published online in the peer-reviewed journal of the American Cancer Society, CANCER.

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