New Lung Cancer Screening Guidelines
New lung cancer screening guidelines recommend annual CT scans only for a select group of people—those aged 55 to 74 who are current or former smokers. The guidelines are the result of a systematic review by an expert panel from several medical groups and were published early online in the Journal of the American Medical Association.
Lung cancer is the leading cause of cancer death among both men and women in the United States. The disease is often detected at an advanced, difficult-to-treat stage.
Cancer screening involves the use of tests to detect cancer at an early stage in people who don’t have any symptoms of the disease. For cancers such as breast cancer, colorectal cancer, and cervical cancer, screening has contributed to decreased rates of cancer death. However, early detection of lung cancer has proven more difficult. In order for new screening methods to be adopted into routine clinical care, the measures must identify cancer early enough to improve outcomes, must be economically feasible, and must detect cancer with an acceptable degree of accuracy. To date no screening measures for lung cancer have been identified that provide a confirmed benefit—but researchers continue to review and evaluate the options.
Low-dose CT scans are a special type of imaging scan that can identify smaller nodules than chest x-rays, making them a strong candidate for lung cancer screening. Although low-dose CT scans can detect lung cancer early, they also can have false-positive results, which means they may not be appropriate for standard use because false-positive results can lead to unnecessary invasive procedures that can have deadly complications. However, in high-risk populations—such as older individuals who are current or former smokers—the benefits of screening with low-dose CT scans may outweigh the harms.
This latest review of the data was a collaborative initiative of the American Cancer Society (ACS), the American College of Chest Physicians (ACCP), the American Society of Clinical Oncology (ASCO), and the National Comprehensive Cancer Network (NCCN) with input from the American Thoracic Society (ATS). It forms the basis for the clinical practices guidelines of the ACCP and ASCO.
The guidelines state that smokers and former smokers ages 55 to 74 who have smoked for 30 pack years or more and either continue to smoke or have quit within the past 15 years should undergo annual screening with low-dose CT scan. The screening should be provided in academic medical centers and other sites with specialized radiologists and surgeons on staff.
Under the new guidelines, about 8 million people would be eligible for annual screening. If all of these people complied with screening guidelines, about 4,000 cancer deaths per year could be prevented.
The researchers concluded that screening lower-risk individuals would offer more harm than benefit.
Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer: A systematic review. Journal of the American Medical Association. Published early online May 20, 2012: doi:10.1001/jama.2012.5521
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