Risks of Lung Screening Seen Outweighing Benefits in Many with Smoking History Very high false-positive screening rate seen in Veterans Affairs study

Caverly, T.J., Fagerlin, A, & Wiener, R.S. (2018, January 22). Comparison of observed harms and expected mortality benefit for persons in the Veterans Health Affairs Lung Cancer Screening Demonstration Project. JAMA Internal Medicine.

1. What research questions are addressed in this study and what is their purpose (5 points)?

2. What type of research design was used (experimental, quasi-experimental, correlational) in this study and what led you to your decision (5 points)?

3. Are the instruments in this study valid and reliable, why or why not (10 points)?

4. Discuss the specific results of each of the ANCOVAs (analysis of covariance) done in this study. What was the purpose of”each” of the ANCOVAs? What was the covariate in each and why did they do an ANCOVA in each case (5 points)?

5. In the Tables, results are presented, Please explain the tables and summarize the results (15 points).

6. Explain, in simple language, any significant results of this study (25 points)?

7. Identify and discuss any threats to internal and/or external validity in this study (10 points).

8. If you could redesign this study correcting anything you have found wrong with the research, what would you correct and how would you do it (20 points)?

Risks of Lung Screening Seen Outweighing Benefits in Many with Smoking History Very high false-positive screening rate seen in Veterans Affairs study

Real-world findings from a Veterans Affairs (VA) population reinforce the need for personalized decision-making about lung cancer screening using validated risk-stratification models. Using the Bach risk tool for assessing lung cancer risk in veterans screened at eight academic VA centers (MSKCC, 2018), nearly 5,600 veterans in the lowest risk quintile needed to be screened to prevent one lung cancer death. Meanwhile, the number of false-positive cases per death averted was 2,221. See generally Caverly, Fagerlin, & Wiener, 2018.

Patients in the highest quintiles of lung cancer risk had significantly more lung cancers diagnosed supporting the model’s ability to stratify risk in this population. These findings, recently published in the Journal of the American Medical Association Internal Medicine (Caverly et al., 2018) bolster those from a VA screening trial published last March (Kinsinger et

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coinvestigatoronaresearch grant fromGenentech·s Corporate Giving Scientific Project Support Program that isunrelated to this study andunrelated to any Genentechor Rocheproducts. No other disclosures are reported.

Roleof theFunde/rSpon sor: The funding sourceshadnorolein thedesign and conduct of th e study: colleciton.management. analysis. and interpretation of the data: preparation. review. or approval of themanuscript: and decision to submit the manuscript for publication.

Disclaimer: Allauthors were employees of the VA at the timethis work was conducted. The viewsexpressed inthis article are those of the authors and do not necessarily represent the views of the VA or the US Government.

Meeting Presentation:Anearlier version of this work was anoral presentation at the 2017 Veterans Affairs Health Services Research &Development (HSR&D)/ Quality Improv ementEnhancement Initiative (QUERI) National Conference: July 18-20. 2017: Arlington. Virginia.

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3. Kovalchik SA.TammemagiM.Berg CD. et al. Targeting of low-dose CT screening according to theriskof lung-cancer death. NEnglJ Med. 2013:369(3): 245-254.

4. BachPB, Elkin EB. Pastorino U. et al. Benchmarkin g lungcancer mortality rates in current andformer smokers. Chest. 2004:126(6):1742-1749.

5. Ten Haaf K, JeonJ. Tammemagi MC. etal. Risk prediction models for selection of lungcancer screeningcandidates: aretrospective validation study. PLoS Med. 2017;14(4):e1002277.

6. Pinsky PF.Gierada OS. Black W. et al.Performance of Lung-RADS in th e National LungScreening Trial: aretrospectiveassessment. AnnInternMed. 2015:162(7):485-491.

jamainternalmedicine.com JAMA Internal Medicine Published onlineJanuary 22.20

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