Smoke out the misperceptions: 5 things lung cancer screening participants believed to be true

Participants in a new lung cancer screening program held a series of common misperceptions about the program’s impact and their own health, according to recent research published by JAMA Internal Medicine. The authors believe that healthcare providers should remain aware of these misperceptions, because they could prove to be potentially harmful to the participants.

For the study, Steven B. Zeliadt, PhD, MPH, of the Center of Innovation for Veteran-Centered and Value-Driven Care and VA Puget Sound Health Care System in Seattle, and colleagues interviewed participants in the Veterans Health Administration (VHA) Lung Cancer Screening Clinical Demonstration Project.

The VHA Lung Cancer Screening Clinical Demonstration Project is a pilot program that uses a system-wide reminder to implement regular lung cancer screening.

Overall, Zeliadt et al. found those taking part in the project held many of the same basic misperceptions about the screening process and what results say about a participant’s health.

“Offering lung cancer screening to current smokers triggers many strong emotions,” the authors wrote. “Health care professionals should be aware that many patients will overestimate the value of screening and that patients will work to interpret the findings in a way that reinforces cognitive biases about their smoking behavior.”

According to the authors, healthcare providers must keep the program’s psychological effects in mind at all times, because it may mean that participants require additional counseling throughout the project.

And if individuals who participate in lung cancer screening don’t learn to let go of their misperceptions and take the effects of smoking more seriously, it is possible that screenings could technically result in more people continuing to smoke.

“These cognitive biases may not be able to be eliminated and lower cessation rates may be an unavoidable harm of screening,” the authors wrote.

Zeliadt and colleagues categorized the misperceptions they encountered into five basic categories:

1. Screening offers protection for everyone who gets screened

Almost every participant expressed the idea that participating in the project would benefit them, even after being shown literature that clearly stated that was not true.

2. Screening can tell how much damage has been caused individually by smoking

Screening is often viewed as a chance to see “how much damage” has been done. In addition, when asked about if they planned to quit smoking, participants would often change the subject and instead discuss how their screening could potentially catch their cancer early.

3. Identification and monitoring of a lung nodule is evidence that cancer can be caught early

Some participants believed the discovery of a nodule or other suspicious findings was a good thing. They would feel “relief” when these things were found and lacked concern.

“Several participants expressed the belief that identification of the nodule meant their cancer had been found so early that it was currently harmless, and that monitoring would tell them when they needed to start treating it,” the authors wrote.

4. Screening reduces likelihood of needing cancer treatment

Participants believed that going through the screening project meant they would be able to avoid cancer screening in the future. “Screening by itself” was seen as a potential cure for cancer if that cancer was found in early enough stages.

5. Smoking doesn’t harm everyone and isn’t going to harm me personally

Participants regularly shared stories about how a family member had smoked his or her entire life and never had any problems.

“Interestingly, even participants who were identified with nodule findings described feeling that their smoking had not yet harmed them because they were not told they have a cancer diagnosis,” the authors wrote.