Radiologists, radiation oncologists and thoracic surgeons are speaking out against lung cancer screening misinformation, spread through recently published scientific papers.
Medical societies representing all three specialties issued a joint statement on Tuesday, criticizing studies claiming such scans pose potential risk of downstream complications, false positives, and dangerous radiation harm. They contend that many of these investigations are based on “substantial methodological flaws that contribute to the propagation of misinformation.”
“Propagating inaccurate test characteristics and overestimating rates of harm likely fuels unwarranted fear of overdiagnosis, overtreatment and iatrogenicity that deters patients from undergoing medically necessary testing and potentially lifesaving LCS,” the American College of Radiology, American Society for Radiation Oncology and Society of Thoracic Surgeons wrote Jan. 20 in JACR.
As one example, ACR, ASTRO and STS cited a 2024 study on rates of downstream medical procedures and complications after lung cancer screening across five U.S. health systems. Published in the Annals of Internal Medicine, the study claimed patients face substantially higher rates of these two concerns compared to others involved in the National Lung Cancer Screening Trial.
However, ACR et al. note that investigators used administrative data for the study, often prone to misattribution, unlike the NLST, which relied on structured medical record reviews. Procedures and complications cited in the study lack clinical context, the physician groups contend, and cannot be attributed to lung cancer screening. Plus, attributing complications for up to one year after baseline screening likely inflates these numbers by including unrelated events well after the initial imaging encounter.
“It is also important to emphasize that the harms of screening should largely be restricted to patients not ultimately diagnosed with lung cancer,” ACR, ASTRO and STS write. “Including procedural complications among patients with confirmed cancer misattributes known therapeutic risks to the screening test itself, a methodological flaw that has been well characterized in analyses of the NLST.”
The societies also highlighted the frequent misreporting of lung cancer screening-related false-positive rates—when an exam inaccurately says someone has the disease. They highlighted a 2023 consensus statement published in the Journal of Thoracic Oncology, which claimed the rate in the NLST was 96.4%. However, this figure represented the false discovery rate, or the proportion of positive screens that did not ultimately represent cancer. Citing this figure creates the false impression that almost every LCS scan represents unnecessary testing, “which is misleading and factually incorrect.”
More than 40 peer-reviewed articles published over the past five years have similarly misquoted this figure.
“Although we commend studies that underscore important LCS considerations—including the need for well-defined, high-quality care pathways and inclusion criteria—the aforementioned methodological issues lead to overestimation of harms,” the societies wrote. “Clinicians and researchers should be mindful of these methodological pitfalls when interpreting LCS data. We encourage journals and the medical community to perform similarly informed, diligent peer review.”
Read more in the Journal of the American College of Radiology.
link