Managing other findings in lung cancer screening: survey highlights urgent need for international guidelines
A summary of research published in Insights into Imaging.
A new survey has highlighted a lack of guidance on how radiologists should manage other findings from lung cancer screening scans. When a person is screened for lung cancer, the scan can sometimes find unexpected health issues in the body. These are known as ‘incidental findings’ — things that are found but were not the main reason for the scan. The lack of guidance and agreement consensus on how to manage these findings is leading to differences in how patients are being supported.
What did this study look at?
A survey of 147 radiologists from 25 countries across Europe aimed to understand what rules radiologists follow for reporting these incidental findings, how familiar radiologists are with the rules and which findings they think should be reported. The survey asked about 20 different health findings from wider issues in the lung and chest area to issues with the heart, liver and bones.
What do the results show?
The survey found large differences in the way other health findings were reported and managed, and in awareness levels among radiologists. Key findings from the survey included:
- The differences in awareness levels were seen even among radiologists from the same country; only four of the countries included in the study showed consistency in responses about other health findings.
- For the majority of the 20 health findings covered by the survey, more than half of the radiologists said they did not have rules they followed on whether they should be reported or not.
- Health issues outside the chest, such as issues with the liver, kidneys or thyroid, were the least likely to have any rules guiding the reporting of them. Fewer than 1 in 10 radiologists said they were always required to report these other findings.
- Almost two thirds of participants agreed or strongly agreed that lung cancer screening scans were not reliable enough to find issues outside the chest.
Why is this important?
Lung cancer screening is rapidly expanding across Europe and more people will receive scans. Without clear guidance on these other health findings, there may be inconsistent care between and within countries. Some people may have minor health issues reported, while others could have important findings missed.
The findings of this survey suggest an urgent need for standardised guidelines to help radiologists know what to report and how to communicate these findings. Although radiologists agree that consistent guidelines are needed, there are challenges. These include a lack of strong evidence on the benefits and risks of reporting other health issues, the costs of this follow-up for health systems and a lack of agreement on which findings are most important.
This paper was part of the EU-funded SOLACE project, which aims to support the roll-out of lung cancer screening in Europe. Find out more.
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