No fear: False-positive lung screening doesn’t significantly increase anxiety

While low-dose CT (LDCT) lung screening has a false-positive rate of 20 percent or higher, an analysis of National Lung Screening Trial (NLST) data showed patient anxiety is not significantly elevated following a false-positive scan compared with a negative result.

The results, published July 25 in Cancer, should alleviate some concerns that a widespread LDCT screening program would result in a slew of stressed-out patients.

Authors Ilana F. Gareen PhD, of Brown University School of Public Health in Providence, R.I., and colleagues stressed that the nature of lung cancer screening makes understanding potential anxiety distinct from other screening programs. While patients screened for breast, colon or cervical cancer receive final diagnoses relatively quickly thanks to biopsy of suspicious lesions, lung biopsies are higher risk and extended monitoring is more often the strategy following a positive lung screen. “These patients may endure an extended period of uncertainty regarding their lung cancer status,” wrote Gareen and colleagues.

A subset of 2,812 NLST participants completed questionnaires assessing short-term and long-term effects of screening. Of these patients, 36.4 percent had a false-positive screen, 12.2 percent had significant incidental findings and 2.2 percent were true positives.

The questionnaires revealed that anxiety at one month and six months after screening did not significantly differ between patients with false-positives, incidental findings or negative results. Health-related quality of life was also similar between these groups of participants, according to the authors.

Short- and long-term anxiety was higher for those with true positive results, while health-related quality of life was worse.

“These findings are relevant to the anticipated adoption of LDCT screening in the United States,” wrote Gareen and colleagues. “They provide evidence that in a large screening program in which participants received extensive counseling as part of the consent process, screening was not associated with high psychological costs for participants who screened positive but were free of lung cancer.”

The authors did recommend that practice guidelines for LDCT screening should include recommendations for counseling patients who receive false-positives or significant incidental findings.

Following the study’s publication, the American College of Radiology (ACR) issued a statement arguing that the fear of harmful patient anxiety due to false-positive screening results should be put to rest and no longer impede implementation of a LDCT screening program.

“Anxiety regarding inconclusive cancer screening test results among some patients is real and is only natural. However, as evidenced by Gareen et al, published July 25 in Cancer, the incidence and effects of anxiety associated with false positive or other results of [CT] lung cancer screening exams are far less than claimed by some in the medical community,” wrote the ACR.