U.S. primary care physicians' lung cancer screening beliefs and recommendations.
BACKGROUND
No high-quality study to date has shown that screening reduces lung cancer mortality, and expert groups do not recommend screening for asymptomatic individuals. Nevertheless, lung cancer screening tests are available in the U.S., and primary care physicians (PCPs) may have a role in recommending them to patients.


OBJECTIVE
This study describes U.S. PCPs' beliefs about and recommendations for lung cancer screening and examines characteristics of PCPs who recommend screening.


METHODS
A nationally representative survey of practicing PCPs was conducted in 2006-2007. Mailed questionnaires were used to assess PCPs' beliefs about lung cancer screening guidelines and the effectiveness of screening tests and to determine whether PCPs would recommend screening for asymptomatic patients. Data were analyzed in 2009.


RESULTS
Nine hundred sixty-two PCPs completed the survey (absolute response rate=70.6%; cooperation rate=76.8%). One quarter said that major guidelines support lung cancer screening. Two thirds said that low-radiation dose spiral computed tomography (LDCT) screening is very or somewhat effective in reducing lung cancer mortality in current smokers; LDCT was perceived as more effective than chest x-ray or sputum cytology. Responding to vignettes describing asymptomatic patients of varying smoking exposure, 67% of PCPs recommended lung cancer screening for at least one of the vignettes. Most PCPs recommending screening said they would use chest x-ray; up to 26% would use LDCT. In adjusted analyses, PCPs' beliefs and practice style were strongly associated with their lung cancer screening recommendations.


CONCLUSIONS
Many PCPs' lung cancer screening beliefs and recommendations are inconsistent with current evidence and guidelines. Provider education regarding the evidence base and guideline content of lung cancer screening is indicated.
Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA. KlabundC@mail.nih.gov
Carrie N
CN
Klabunde
Pamela M
PM
Marcus
Gerard A
GA
Silvestri
Paul K J
PK
Han
Thomas B
TB
Richards
Gigi
G
Yuan
Stephen E
SE
Marcus
Sally W
SW
Vernon
D001291:Attitude of Health Personnel; D055088:Early Detection of Cancer / Q000592:standards / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D008297:Male; D058007:Physicians, Primary Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D013902:Radiography, Thoracic; D012907:Smoking / Q000009:adverse effects; D013183:Sputum / Q000737:chemistry / Q000382:microbiology; D015996:Survival Rate; D036542:Tomography, Spiral Computed / Q000639:trends; D014481:United States / Q000453:epidemiology