Invasive Procedures and Associated Complications Following Initial Lung Cancer Screening in a National Cohort of Veterans

Balancing the Benefits and Harms of Lung Cancer Screening

“…Although the population was similarly more medically complex than the NLST cohort (54.8% vs 29.5% with two or more comorbidities), the rate of procedures (biopsy, bronchoscopy, and thoracoscopy) was 58% to 210% higher than in the NLST. 1,6 Interpreting the findings of lower procedure rates reported by Nuñez et al 3 is challenging without knowing the rate of positive LCS examinations in their study. Lower procedure rates raise the possibility that some patients are not being offered appropriate diagnostic procedures for screen-detected nodules.…”

“…The patients studied were more medically complex than those in the NLST, with higher rates of COPD (33.2% vs 17.5%), heart disease (16.6% vs 12.9%), stroke (4.1% vs 2.8%), and interstitial lung disease (1.6% vs 0.3%). 3,4 Although the procedural rate was onehalf that of the NLST (2.1% vs 4.2%), the overall major or intermediate complication rate per number of patients who underwent a procedure was similar (19.1% vs 18.9%, respectively). The authors implied that the lower procedure rates in their study suggest that comorbid diseases may play a role in patient selection for downstream interventions following LCS, noting a lack of association between COPD and complication rate (OR, 1.17).…”

“…It is also challenging to interpret the higher surgical complication rates reported by Nuñez et al 3 without knowing which surgical procedures were performed. In a retrospective Surveillance, Epidemiology, and End Results (SEER) registry of > 9,000 patients aged > 65 years undergoing surgery for stage I to II lung cancer between 2000 and 2009, VATS was associated with a reduced risk of cardiovascular (OR, 0.68) and thromboembolic (OR, 0.60) complications, transfusion requirements (OR, 0.57), extrapulmonary infections (OR, 0.71), and shorter length of hospital stay (OR, 0.49).…”

“…13 This rate compares to national rates for minimally invasive procedures but is lower than the 80% to 90% rate among Society of Thoracic Surgeons members. 14 The study by Nuñez et al 3 reiterates potential harms from screening, lending further support for research to develop tools to identify high-risk, high-benefit LCS individuals and assess the balance of life-years gained from LCS against risks of competing mortality from underlying comorbidities. 15 Moreover, the study supports that older and racially diverse individuals with more medical comorbidities cared for in real-world LCS settings are at risk for procedural complications following screening.…”