Spiral CT screening for lung cancer – pro

Prior to the release of the National Lung Screening Trial (NLST) results in November 2010 that showed that CT screening of high-risk individuals reduced their risk of lung cancer death, no organization recommended routine screening for lung cancer.

A 2009 review of American Cancer Society guidelines states that neither the ACS nor any other medical or scientific organization recommends screening for early lung cancer with CT scans or chest radiographs in asymptomatic individuals.

The 2007 American College of Chest Physicians’ (ACCP) guidelines on screening for lung cancer does not recommend low-dose CT, and specifically recommends against the use of serial chest radiographs for lung cancer screening.

In May 2004, the U.S. Preventive Services Task Force (USPSTF) concluded that there was insufficient evidence to recommend for or against screening asymptomatic persons for lung cancer with low-dose CT, chest x-ray, sputum cytology, or a combination of these tests due to poor evidence that screening would reduce lung cancer mortality rates.

However, not all study details have been released for careful review by doctors and scientists other than those who conducted the study. For that reason, medical groups, including the American Cancer Society, don’t yet recommend lung cancer screening to smokers and former smokers. There remain concerns about radiation and cost.

In July 2013, The United States Preventive Services Task Force (USPSTF) has issued a draft statement recommending that certain people at high risk for lung cancer get a low-dose CT scan every year. This is also ASCO and NCCN recommendation as of 2013.

The National Lung Screening Trial (NLST) study determined that low-dose helical computed tomography (CT) scans can reduce lung cancer mortality for current and former heavy smokers.  In the nation-wide study, which included over 53,000 participants, researchers found 20 percent fewer lung cancer deaths among those who were screened. However, at this time (2011), NCCN does not recommend routine screening with spiral CT (PREV-1).

The most recent review in Jama (Bach et al 2012) concluded: “Low-dose computed tomography screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalizability of results.” However, in 2013, the recommendations for spiral CT surveillance have been adopted by NCCN and other guidelines.

Peter B. Bach, MD, MAPP; Joshua N. Mirkin, BA; Thomas K. Oliver, BA; Christopher G. Azzoli, MD; Donald A. Berry, PhD; Otis W. Brawley, MD; Tim Byers, MD, MPH; Graham A. Colditz, MD, DrPH; Michael K. Gould, MD, MS; James R. Jett, MD; Anita L. Sabichi, MD; Rebecca Smith-Bindman, MD; Douglas E. Wood, MD; Amir Qaseem, MD, PhD, MHA; Frank C. Detterbeck, MD Benefits and Harms of CT Screening for Lung Cancer:  A Systematic Review JAMA. 2012;307(22):2418-2429

Smith RA, Cokkinides V, Brawley OW. Cancer screening in the United States, 2009: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 2009; 59: 27-41.

Alberts WM; American College of Chest Physicians. Diagnosis and management of lung cancer: executive summary: ACCP evidence-based clinical practice guidelines (2nd Edition). Chest 2007; 132(3 Suppl): 1S-19S.

U.S. Preventive Services Task Force. Screening for Lung Cancer. May 2004. Available online at: http://www.ahrq.gov/clinic/3rduspstf/lungcancer/lungcanrs.htm. Last accessed September 14, 2010.

Nccn.org, Prevention 2014

Richard Wende American Cancer Society lung cancer screening guidelines. CA: A Cancer Journal for Clinicians Volume 63, Issue 2, pages 106–117, March/April 2013

Nccn.org, Prevention 2014

The National Lung Screening Trial Research Team. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine, 2011

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