Commentary: Prevention is possible: Our responsibility is real

Central MessageAs a surgical society, it is our responsibly to remind that prevention saves lives.See Article page 336. As a surgical society, it is our responsibly to remind that prevention saves lives. See Article page 336. The authors Kamel and colleagues1Kamel M.K. Kariyawasam S. Stiles B. Overestimation of screening-related complications in theNational Lung Screening Trial.J Thorac Cardiovasc Surg. 2023; 166: 336-344.e2Scopus (1) Google Scholar have put forward a very interesting paper that truly challenges us as a surgical society. They clearly articulate that although there has been existing evidence, for more than a decade, that low-dose computed tomography (LDCT) screening for lung cancer saves lives, we have a paucity of engagement, with only 1 in 15 eligible individuals for LDCT screening actually completing this preventative intervention.2Aberle D.R. Adams A.M. Berg C.D. Black W.C. Clapp J.D. Fagerstrom R.M. et al.National Lung Screening Research TeamReduced lung-cancer mortality with low-dose computed tomographic screening.N Engl J Med. 2011; 365: 395-409Crossref PubMed Scopus (7282) Google Scholar,3National Lung Screening Trial Research TeamLung cancer incidence and mortality with extended follow-up in the National Lung Screening Trial.J Thorac Oncol. 2019; 14: 1732-1742Abstract Full Text Full Text PDF PubMed Scopus (204) Google Scholar When there is such clear scientific evidence that lives can be saved, there must be a complex multifactorial reason for such a low uptake. Kamel and colleagues1Kamel M.K. Kariyawasam S. Stiles B. Overestimation of screening-related complications in theNational Lung Screening Trial.J Thorac Cardiovasc Surg. 2023; 166: 336-344.e2Scopus (1) Google Scholar focused on cited “potential harms” of screening as a variable that may influence uptake. This was initially unclear as to the why, but as the authors have stated, complications are often tracked and always spoken of.1Kamel M.K. Kariyawasam S. Stiles B. Overestimation of screening-related complications in theNational Lung Screening Trial.J Thorac Cardiovasc Surg. 2023; 166: 336-344.e2Scopus (1) Google Scholar As outlined in the featured paper, the risk of complications in patients undergoing screening is very low and that for those who undergo screening yet turn out to not have lung cancer, almost inexistent.1Kamel M.K. Kariyawasam S. Stiles B. Overestimation of screening-related complications in theNational Lung Screening Trial.J Thorac Cardiovasc Surg. 2023; 166: 336-344.e2Scopus (1) Google Scholar This is likely a result of to the standardized processes that many cancer centers have developed when faced with patients with lung nodules, including diagnostic imaging, biopsy protocols, and oncology clinical pathways.4Zhang Y. Simoff M.J. Ost D. Wagner O.J. Lavin J. Nauman B. et al.Understanding the patient journey to diagnosis of lung cancer.BMC Cancer. 2021; 21: 402Crossref PubMed Scopus (7) Google Scholar So, once within the system, after applying the appropriate LDCT parameters, which have now been expanded, the system works and has been proven to reduce lung cancer mortality.3National Lung Screening Trial Research TeamLung cancer incidence and mortality with extended follow-up in the National Lung Screening Trial.J Thorac Oncol. 2019; 14: 1732-1742Abstract Full Text Full Text PDF PubMed Scopus (204) Google Scholar However, we need to get patients into the system. So perhaps we need to get people's attention by focusing on obvious complications, or the lack therein, and perhaps we talk about complications because it easier than addressing the elephant in the room: the system-level barriers to screening and preventing deaths. Have we not yet realized that through prevention, we can prevent harm? The paper by Carter-Harris and Gould5Carter-Harris L. Gould M.K. Multilevel barriers to the successful implementation of lung cancer screening: why does it have to be so hard?.Ann Am Thorac Soc. 2017; 14: 1261-1265Crossref PubMed Scopus (55) Google Scholar is so appropriately titled: “Multilevel Barriers to the Successful Implementation of Lung Cancer Screening: Why Does It Need to Be So Hard?” There are many layers to the system and range from the patient, the providers, and overall health care system. Each one of these layers has so many barriers that we have yet to address in a holistic approach and include very real yet disjointed programs around patient and provider education, access to screening programs, and system supports for those who ultimately need lung cancer care. We have learned over the past several years that our system is fragile and one that has little-to-no equity. We have work to do as a society. We must therefore, as a surgical society, continue to remind that through prevention we cure more patients (Figure 1). We must address the systems issues we have influence over and advocate for those we don't. We must always be ready to sit at the table and think of those voices not heard; those patients we might have cured had we succeeded in prevention. This is our responsibility to remind and prevent. Overestimation of screening-related complications in the National Lung Screening TrialThe Journal of Thoracic and Cardiovascular SurgeryVol. 166Issue 2PreviewLung cancer screening-associated complications are often quoted as one of the major barriers for wider screening adoption. A detailed analysis of the National Lung Screening Trial dataset was performed to extrapolate the safety of lung cancer screening. Full-Text PDF