In Lung Cancer Screening, Few Primary Care Physicians Order Low-Dose CT

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Doctors who know guidelines more likely to order low-dose computed tomography.
Doctors who know guidelines more likely to order low-dose computed tomography.

Few primary care providers (PCPs) order low-dose computed tomography (LDCT) for lung cancer screening in patients at high risk, according to a study presented at the 2014 Chicago Multidisciplinary Symposium in Thoracic Oncology, held from Oct. 30 to Nov. 1.

Jennifer Lewis, M.D., from the Wake Forest School of Medicine in Winston-Salem, N.C., and colleagues examined lung cancer screening use and potential barriers to LDCT use. Data were collected from surveys of 293 respondents.

The researchers found that few PCPs reported ordering lung cancer screening examinations (chest X-ray, 21 percent; LDCT, 12 percent; and sputum cytology, 3 percent). About half of providers (48 percent) knew at least three of the six guideline components for LDCT screening; one-quarter (24 percent) did not know any components.

Providers who knew three or more components were more likely to order LDCT (odds ratio, 5.0). Thirty percent of providers reported being unsure of LDCT effectiveness in reducing cancer mortality, and these providers had not ordered LDCT. A majority of providers (80 percent) expressed interest in receiving more education about lung cancer screening.

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Patient cost, potential harm from false-positive findings and incidental findings, patients' lack of awareness, and no insurance coverage were reported as the most commonly perceived barriers to LDCT screening.

"The results of this survey highlight an essential need for provider education on the effectiveness of low-dose CT screening for lung cancer, on lung cancer screening guideline recommendations, and the potential benefits and harms of screening," Lewis said in a statement.


  1. "Patients at high-risk for lung cancer are more likely to receive screening when primary care provider is familiar with guideline recommendations." ASTRO. October 30, 2014.

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