CONTENTS:

1.11 Summary of Lung Cancer Screening Guidelines.

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1.11 Summary of Guidelines for Lung Cancer Screening

, systematic reviews of all available published evidence from clinical trials were commissioned by the following organizations:

Indeed, cohort studies and clinical trials provide evidence for the benefits of lung cancer screening. Furthermore, such studies use screening techniques with chest X-ray or low-dose CT (LDCT). The findings from the main studies are 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.
The NCCN define those at ‘high risk’ for lung cancer as between 55 to 74 years with 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.
Any lung cancer screening program will ideally include a multidisciplinary team. Indeed the multidisciplinary team involves radiology, pathology, pulmonary medicine, internal medicine, thoracic oncology, and / or thoracic surgery.
Patient counselling before lung cancer screening is always important 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.

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Identifying lung cancer screening Guidelines

lung cancer screening guidelines 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 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:

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.

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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 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.

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

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

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:

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
The relatively low number of cancer diagnoses.
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 database data and reported that the current evidence does not support screening for lung cancer with chest radiography or sputum cytology. Manser reports that in high-risk smokers annual low-dose CT screening leads to a reduction in lung cancer mortality. However, Manser concludes more data is necessary regarding the cost effectiveness of screening. In addition, according to Manser, more evidence is needed regarding the relative harm and benefits of lung cancer screening. Finally, click the link 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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