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The clinical evidence base for low-dose CT (LDCT) lung cancer screening is rapidly advancing and the case for implementing a UK programme building. This is welcome news to the lung cancer community whose patients too often face a bleak prognosis, in part because early diagnosis is so infrequent. Relatively less attention, however, has been paid to the potential psychological responses of high-risk individuals to such a screening programme; something which should inform policy decision-makers and shape healthcare professionals' practice of screening, to maximise patient benefit and well-being.
Previous research on screening for other types of cancer has shown there is potential for patients to experience distress at any point along the screening pathway. An individual's propensity to experience distress in response to cancer screening may be determined in part by the nature of the result they receive and any ensuing tests or surveillance, as well as their psychosocial characteristics.1 In Thorax, Brain et al provide an invaluable contribution to both these aspects and the first from the UK; reporting the long-term psychosocial outcomes of screening among participants in the UK Lung Screening (UKLS) trial.2
The psychological cost of abnormal findings is especially important to understand in the context of LDCT lung cancer screening because they are frequent, with an average pulmonary nodule detection rate of 20% across trials.3 In the US National Lung Screening Trial (NLST), 39% of participants received a positive screening result for one of their three annual screens, of which 96% were false positives.4 Incidental findings (ie, medical conditions other than lung cancer) were also a common outcome for screenees, affecting 10% of NLST participants following their prevalence (first) screen.4 The UKLS investigators made a distinction between false positive and indeterminate results based on their clinical management. Pulmonary nodules …