Is low-cost an added benefit to widespread lung cancer screening? According to this article, from April’s Health Affairs—yes! The study on this much debated about topic asserts that routine CT lung cancer screening of high-risk individuals would save thousands of lives annually for less than one dollar a month per patient, if implemented throughout the US. According to these figures, the cost of low-dose lung cancer screening could be less than that for both breast cancer screening and colorectal cancer screening.
As we’ve pointed out, lung cancer screening is effective and life saving. For high- risk patients, those who are multiple pack year smokers for 25 years or more, screening provides significant benefits. For these individuals, low-dose CT screening reduces the number of lung cancer deaths by 20 percent!
Despite this, widespread lung cancer screening has yet to be implemented nationwide, largely due to cost. This study reports interesting and encouraging data about widespread implementation of the procedure, though. However, we must remember that there are also reputable articles which report much higher cost numbers when adjusted for quality-life-years saved. It is necessary to take these studies into account, too.
Research published in this month’s American Journal of Roentgenology reported excellent results on a protocol for working up patients with nodules found in CT lung screening. Ever since the National Lung Screening Trial showed a 20% mortality reduction among high-risk patients screened for the disease, criticism has been vocalized due to the potentially large number of false-positive results following diagnostic imaging investigations. Though the possibility of finding cancer outweighs the risk of false positives, the researchers argued that false-positive results could potentially increase the risks and costs of screening, diminishing the benefit of early cancer detection.
This study, which required participants without a history of cancer to have smoked a minimum of 10 pack-years, concluded with positive results. According to the research, the algorithm produced low false-positive rates, and could make the establishment of large-scale CT screening programs more feasible.
Follow-up CT protocols in lung cancer screening – once a finding is discovered and needs to be evaluated over time or even just routinely on a schedule – is one area ripe for ultra low-dose CT technique. With this technique, we really can see doses reduced by 40 – 80% among these applications! Accepting higher noise in images, very low-dose kVp (in the 80-100 range), and aggressive application of iterative reconstruction techniques can produce diagnostic CT results at breathtakingly low doses.