The study included 174,702 individuals ages 55-77 who had invasive diagnostic procedures and a matched-control group of 169,808 individuals who did not have these procedures to determine a baseline level for complication rates.
“We wanted to understand what the real-world costs and complications might be for diagnostic procedures that typically occur after abnormal results from LDCT screening,” said Shih. “Although we weren’t able to examine a linear path from LDCT screening to invasive diagnostics, the incremental approach applied in our study gives us an estimate of downstream adverse events for these types of procedures in the community setting.”
Risks of complications should be shared in patient communications
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Among younger individuals (55-64), post-procedural complication rates were 22.2 percent in the study, compared to just 9.8 percent in the NLST. For older individuals (65-77), complication rates were 23.8 percent in the current study and 8.5 percent in the NLST.
The researchers also performed an analysis of associated downstream costs from post-procedural complications. Managing these complications resulted in higher costs on average than the diagnostic procedures, ranging from $6,320 for minor complications to $56,845 for major complications.
“It’s very important for physicians to include information about possible adverse risks when communicating with their patients considering lung cancer screening,” said Shih. “Our findings suggest these complications may be higher than anticipated when implementing lung cancer screening programs outside a clinical-trial setting, and the health care system needs to be ready for that potential issue.”
Shih points out that those having invasive procedures for abnormal findings are a small percentage of all those being screened for lung cancer, likely less than 5 percent, and lung cancer screening appears to have benefit for those meeting the screening eligibility requirements. Still, it is important to share potential harms and benefits with patients considering lung cancer screening, especially those interested in LDCT screening that do not meet the eligibility criteria.
This study was limited by its retrospective nature and the fact that the most relevant data was unavailable to the researchers at the time of the study. When data becomes available to show which individuals had invasive procedures subsequent to LDCT screening, the researchers will perform more direct analyses in that group.
