ORLANDO, FL—The downstream effects of government recommendation to screen at-risk individuals for lung cancer may mean that medical schools should gear up to turn out more thoracic surgeons, researchers suggested here at the Society of Thoracic Surgeons (STS) Annual Meeting.
Using a microsimulation model, researchers in Canada found an expected 30 percent increase in Stage 1A lung cancer diagnoses with a subsequent major increase in cases requiring surgical procedures.
“The introduction of a national CT screening program for lung cancer leads to a relative increase in diagnosis of early-stage lung cancers and increased surgical volume,” said Janet Edwards, MD, MPH, a thoracic surgery resident at the University of Calgary. “A national strategy for thoracic surgery workforce planning is necessary to ensure the needs of the future population.”
To keep up with the workload, Canadian medical schools will have to educate and train more thoracic surgeons, she suggested in her poster presentation. However, she said in an interview, “This work is informative, but as with this or any model, it may contain inherent biases.”
The researchers suggest that medical schools would have to double the number of thoracic surgeons being trained in order to maintain the current caseload for surgeons. “The increase per surgeon in the United States may be different based on different medical systems, but our microsimulation model might be a tool that may be built to reflect an American system on a state level. For example, the population of Canada approximates that of California.”
Asked for his opinion, though, Andrew Chang, MD, the John Alexander Distinguished Professor and Head of the Section of Thoracic Surgery at the University of Michigan, agreed that the situation in the United States will be very similar.”
He explained that because screening tends to pick up cancers at an early stage, the cancers are most likely going to be removed by surgery. More detection and more surgeries will increase the need for more surgeons, he said.
The United States Preventive Service Task Force recommends annual screening for lung cancer with low-dose computed tomography in adults age 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The agency recommends that screening be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or there is the ability or willingness for the patient to have curative lung surgery. The recommendations by Canadian authorities mirror the U.S. recommendations, Edwards noted.
She and her colleagues created the model, which represents the population of Canada and which the researchers suggest will increase in size from the current population of 34.7 million to 46 million by 2049. The model anticipates that CT screening for lung cancer will peak in 2017. By 2040, screening with CT is likely to increase the diagnoses of lung cancer by seven percent; the increase in Stage 1 lung cancer will be 27 percent more than the current detection rate by 2020; it will increase by 23 percent by 2030; and by 2040, it will increase by 16 percent.
The researchers suggested that even without CT screening, the absolute increase in operable lung cancer will increase by 46 percent until 2030. “With screening the number of operable cancers will increase by 76 percent before that number begins to decline,” Edwards said.
“The introduction of interventions such as CT screening can have a domino or downstream effect. That is why organization like STS are engaged and involved in workforce planning and setting up national guidelines for CT screening to ensure wise use of resources. The STS has been engaged with other medical societies and government agencies to assess different perspectives on CT screening.”
Edwards noted that it has been shown that screening of high-risk individuals with CT decreases mortality due to lung cancer by two percent but that the impact of CT screening programs on the thoracic surgical workforce had not been known.
In their study, the researchers assumed that a base of 100 early lung cancers would be seen by each thoracic surgeon. The model showed that by 2030 the rate of operable early lung cancers per thoracic surgeon will be 173 without screening and 239 cases with screening. “Doubling the current number of trainees would still result in an increase to 134 operable lung cancers per surgeon,” Edwards said.
“As jobs become more competitive in certain areas of medicine, thoughtful workforce planning may identify areas of need so that residents may make informed career choice decisions. We anticipate a bright future for thoracic surgery with jobs available for new thoracic surgeons, a finding supported by the results of our research.”
She said that small variations in the number of new thoracic surgeons entering the labor market per year will have an important impact on the operative caseload per surgeon.
“We are going to be busy,” Chang said, noting that the study's principal investigator, Sean Grondin, MD, MPH, Associate Professor of Thoracic Surgery at the University of Calgary, is recognized as one of the important thinkers in this area. “This is a thought-provoking study, but it kind of makes sense.
“While the increase is projected to continue until 2025 or 2030, there may be some relief due to smoking-cessation programs,” he suggested. He noted that while smoking is decreasing in the United States and Canada, and the incidence of lung cancer appears to be slowing, there are still many people who remain at increased risk of lung cancer that might be picked up through screening programs.
“The problem really isn't going to be whether we can train enough surgeons. The problem in the United States is that there is talk of cutting back on funding residencies at the time we have an aging population and this screening program, which will bring us more patients.”