Diagnostic Imaging's Weekly Scan: March 12, 2021

March 12, 2021
Whitney J. Palmer

USPSTF lung cancer screening recommendation update; Cancer screenings and COVID-19; and CT and unintentional weight loss.

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview – a re-visit with Dr. Anupam Basu in light of this week’s announcement from the U.S. Preventive Services Task Force about its changing recommendation for lung cancer screenings – here are the top stories of the week.

Speaking of that change in lung cancer screening recommendation – the U.S. Preventive Services Task Force announced two significant changes to its existing guidance about when smokers should begin low-dose CT for lung cancer screening. The original recommendation supported annual low-dose CT screening for smokers or former smokers who were between ages 55 and 80 who had 30 pack-year histories or who had stopped smoking within the last 15 years. Based on new research on screening efficacy, the Task Force published their amendments in JAMA. The new guidance now supports annual screening for smokers and non-smokers between ages 50 and 80 with 20 pack-year histories or smoking cessation within the past 15 years. This move, the Task Force says will give 6.4 million more people access to screening – that’s an 81 percent increase. The hope, the Task Force said, is that this move will make it easier for previously under-screened groups to get the scans they need for earlier detection and earlier treatment. This could be particularly impactful with African American smokers who have worse outcomes with lung cancer despite having pack-year histories that fell below the previous 30-year threshold. The supporting research also revealed making this change helped avoid more deaths – between 469 and 588 per 100,000 for patients with 20 pack-year histories versus 381 per 100,000 for patients with 30-year histories, and they also gained more life years – 6,018-to-7,596 years per 100,000 patients compared with 4,882 per 100,000 for patients with 30-year histories. Still, the research did point to more false positives, over-diagnosis, and other radiation-induced cancer deaths with the increased eligibility for screening.

It has been no secret that the COVID-19 pandemic has had a chilling effect on cancer screenings nationwide – fear of viral exposure, a shortage of PPE for providers, a patient’s inability to pay for the service, and inconsistent guidance from the CDC all created the perfect storm for fewer patients coming in for the screenings they need, particularly screening mammography and lung cancer screenings. This week, Dr. Mina Makary, and interventional and diagnostic radiologist from The Ohio State University took a look at the lingering impact of the pandemic and how radiology practices should proceed to bring patients back in for screening services in a safe, efficient way.

Patients do not typically seek treatment for unintentional weight loss in the emergency department, but for the 5 percent to 7 percent who do, CT scans can help providers shed light on what might be behind the problem. In a study published in Emergency Radiology, investigators from University Hospitals Cleveland Medical Center and Case Western Reserve University showed that, as a first-line imaging approach, CT can offer a true-positive rate of 48.8 percent for identifying organic causes of unintentional weight loss. For their study, they included 133 patients who had chest, abdomen, or pelvis CT scans in their emergency department between 2004 and 2020. Based on their analysis, they determined CT made 65 true-positive detections – 41 cases of non-malignant gastrointestinal conditions and 30 cases of cancer. They also saw that elevated white blood cell counts and physical exam irregularities were also significantly associated with CT abnormalities.

And, finally, this week, we’re taking a look back at an interview with Dr. Anupam Basu from Cook County Hospital in light of this week’s lung cancer screening announcement from the U.S. Preventive Services Task Force. He recently published a study in the Journal of the American College of Radiology that revealed the previous 30 pack-year history was too high a threshold for African American smokers. He spoke with us about the details of his findings, what they mean for African American smokers, and how radiologists can use this information. Here’s what he had to say.

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