CONTENTS:

1.11 Summary of Guidelines for Lung Cancer Screening.

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Studies have shown that most people don’t finish what…….

1.11 Summary of Guidelines for Lung Cancer Screening

lung-ca-betty In 2012, systematic reviews of all available published evidence from clinical trials were commissioned by the following organizations:

Evidence for any benefits of lung cancer screening have been derived from cohort studies and randomized clinical trials using screening with chest X-ray or low-dose CT (LDCT). The findings can be summarized as follows:

Remember, the main aim of lung cancer screening is to catch and treat the disease earlier thereby reducing mortality rates.

LDCT screening is more sensitive than chest X-ray for identifying small, non-symptomatic lung cancers.
‘High risk’ for lung cancer has been defined by the NCCN to include age between 55 to 74 years and a 30 pack-year history of smoking. When a former smoker, smoking cessation within the past 15 years; or a 20 pack-year history of smoking plus one additional risk factor (other than second-hand smoke exposure).
Chest X-ray and LDCT screening have high rates of ‘false-positive’ (non-cancer) findings, leading to additional testing (second-line testing) that usually includes serial imaging but may include invasive procedures.
The most common ‘incidental’ findings, on first-line imaging, are emphysema and coronary artery calcifications.
Lung cancer screening should be done within the context of a multidisciplinary team (MDT) program: radiology, pathology, pulmonary medicine, internal medicine, thoracic oncology, and / or thoracic surgery.
Patient counseling should be given to explain the risks and benefits of lung cancer screening.
The development of a data registry to include smoking history, any follow-up testing, smoking behavior, radiation exposure, and feedback from patients.

Is middle age called that because your age starts to show around your middle?

lung-ca-phil The purpose of these clinical trials to evaluate lung cancer screening is to allow for the development of evidence-based clinical guidelines. There is some lack of agreement in attitudes to lung cancer screening, worldwide; this is reflected in the guideline recommendations in those countries that do have lung cancer screening programs.

This is a summary of the key clinical trials, so far:

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National Comprehensive Cancer Network (NCCN), 2011:

Recommends annual low-dose CT (LDCT) scans for high-risk individuals, aged 55 to 74 years with lung-ca-sophie's-mum a 30 pack-year smoking history or 20 pack-year history with an additional risk factor. More information on this trial.

American Association of Thoracic Surgery (AATS), 2012:

Recommends annual low-dose CT (LDCT) scans for high-risk individuals, aged 55 to 74 years with a 30 pack-year smoking history who currently smoke or who quit smoking within the last 15 years, or age 50 with a cumulative risk > 5% over the next 5 years. lung cancer screening on this trial.

American College of Chest Physicians (ACCP) / American Society of Clinical Oncology (ASCO), 2012:

accord-1 Recommends annual low-dose CT (LDCT) scans for high-risk individuals, aged 55 to 74 years with a 30 pack-year smoking history who currently smoke or who quit smoking within the last 15 years. Before testing, patients are to be informed of the reasons for the decision. More information on this trial.

I have no faith in my doctor – all his patients are ill!

American Cancer Society (ACS), 2013:

Recommends annual low-dose CT (LDCT) scans for high-risk individuals, aged 55 to 80 years with a 30 pack-year smoking history who currently smoke or who quit smoking within the last 15 years. Screening to be discontinued after 15 years of non-smoking or if life expectancy is lung-ca-bernard limited. More information on this trial.

US Preventive Services Task Force (USPSTF), 2013:

Recommends annual low-dose CT (LDCT) scans for high-risk individuals, aged 55 to 80 years with a 30 pack-year smoking history who currently smoke or who quit smoking within the last 15 years. Screening to be discontinued after 15 years of non-smoking or if life expectancy is limited. More information on this trial.

The American Cancer Society and the Preventive Services Task Force are in complete agreement. That’s got to be good.

Yes but who are the Preventive Services Task Force? They sound military.

They are an independent voluntary group of experts in prevention and evidence-based medicine.

The American Association of Family Practitioners (AAFP), 2013:

lung-ca-jason At the present time, the AAFP concludes that there is insufficient evidence to recommend for or against screening for lung cancer with low dose computed tomography (LDCT). See report.

Canadian Task Force on Preventive Health Care, 2014:

Recommends against the use of chest X-ray in asymptomatic individuals. There is considered to be insufficient evidence for or against to recommend screening in asymptomatic individuals. See report.

The U.K. Health Technology Assessment (HTA) Programme 2015:

jenny At the moment there is no national screening program for lung cancer screening in the UK. The reasons that are given include:

Lack of a sensitive enough test
Low number of cancers that would be found
High costs involved
Risks of current tests

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In 2013, Manser and colleagues systematically analyzed the clinical trial data and the Cochrane lung-ca-keith database data and reported that the current evidence does not support screening for lung cancer with chest radiography or sputum cytology. They reported that annual low-dose CT screening is associated with a reduction in lung cancer mortality in high-risk smokers but that further data are required on the cost effectiveness of screening and the relative harms and benefits of screening across a range of different risk groups and settings. For more information on this analysis.

On 5^th February 2015, in the U.S., The Centers for Medicare & Medicaid Services (CMS) made the following decision statement:

‘the evidence is sufficient to add a lung cancer screening counseling and shared decision making visit, and for appropriate beneficiaries, annual screening for lung cancer with low dose computed tomography (LDCT), as an additional preventive service benefit under the Medicare program only if all of the … criteria are met’.

See the full CMS decision document.

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REFERENCES:

Manser RL, Irving LB, Stone C, Byrnes G, Abramson M, Campbell D. (2013). Screening for lung cancer. Cochrane Database Syst Rev. 6, CD001991. (Retrieved 22^nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/23794187

Smith RA, Manassaram-Baptiste D, Brooks D, et al. (2014). Cancer screening in the United States, 2014: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin 64(1), 30–51. (Retrieved 22^nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/24408568

More references for this section are on this page.

PATIENT INFORMATION:

Centers for Disease Control and Prevention (CDC)Lung Cancer Screening Guidelines and
Recommendations. http://www.cdc.gov/cancer/lung/pdf/guidelines.pdf (Retrieved 5^th April 2015): http://www.cdc.gov/cancer/lung/pdf/guidelines.pdf

American College of Chest Physicians (ACCP) / American Society for Clinical Oncology (ASCO) 2012 Guidelines on Screening for Lung Cancer. (Retrieved 22^nd Jan 2015): http://jama.jamanetwork.com/article.aspx?articleid=1163892

More patient information for this section is on this page..

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