What do U.S. Primary Care Physicians Know and Believe about Lung Cancer Screening?

Background: High-quality studies have not shown screening to reduce lung cancer mortality and expert groups do not recommend screening for asymptomatic individuals. Nevertheless, there is a U.S. market for lung cancer screening tests. Primary care physicians (PCPs) may have a role in recommending them to patients. This study assesses PCPs' lung cancer screening beliefs and recommendations.

Methods: A 2006-2007 national survey of PCPs collected information on their knowledge of lung cancer screening guidelines; beliefs about the effectiveness of screening tests; and whether they would recommend screening for asymptomatic patients by smoking status. Descriptive statistics characterized PCPs' knowledge, beliefs, and recommendations. Logistic regression modeling assessed characteristics of PCPs who would recommend screening for asymptomatic patients.

Results: A total of 962 family physicians, general practitioners, and general internists responded (cooperation rate=75.0%). In response to a set of vignettes describing patients of varying smoking exposure, 32% of PCPs would not recommend lung cancer screening for any patient while 17% would recommend screening for all. In adjusted analyses, PCPs who were more aggressive in their lung cancer screening recommendations lacked Board certification (OR=2.5; 95% CI:1.2-5.2), were international medical graduates (OR=3.0; 95% CI:1.7-5.3), believed that guidelines support lung cancer screening (OR=3.4; 95% CI:1.8-6.6) and that lung screening tests are very effective (OR=7.0; 95% CI:1.8-27.5), and were aggressive in their colorectal cancer screening recommendations (OR=2.9; 95% CI:1.8-4.7).

Conclusions: The lung cancer screening knowledge, beliefs, and recommendations of many U.S. PCPs are inconsistent with current evidence and guidelines. There is considerable heterogeneity in PCPs' beliefs and recommendations.