CONTENTS:

2.2.2 When is Lung Cancer CT Screening Medically Necessary?
2.2.3 When is CT Screening Investigational and Not Medically Necessary?
2.3 Lung Cancer Prevention: Special Populations and Lung Cancer Screening
2.3.1 Screening Recommendations for Lung Cancer Survivors

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Plan to be spontaneous. Tomorrow.

2.2.2 When is Lung Cancer CT Screening Medically Necessary?

Lung screening using low-dose CT imaging is considered to be medically necessary when used for certain high-risk individuals, but when all of the following criteria are met:

1)   The individual is asymptomatic and has no signs or symptoms suggestive of an underlying lung cancer, such as unexplained cough, hemoptysis, or unexplained weight loss of more than 15 pounds in the past year.

2)   The individual is between 55 and 80 years of age.

3)   There is at least a 30 pack-year history of cigarette smoking.

4)   If the individual is a former smoker, that individual has given up smoking within the previous 15 years.

5)   Screening will occur no more often than annually.

The American Association for Thoracic Surgery (AATS) released their 2012 guidelines for lung cancer screening.   In these guidelines, they recommended that annual lung cancer screening with low-dose CT (LDCT) should occur for certain individuals aged between 55 and 79 years of age.

The American College of Chest Physicians (ACCP) made similar recommendations in their 2013 clinical practice guidelines for screening for lung cancer.

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The National Comprehensive Cancer Network Screening Guidelines

The National Comprehensive Cancer Network (NCCN) 2014 Lung Cancer Screening Guidelines recommended annual, low-dose CT but only until ‘at-risk‘ individuals are no longer eligible for definitive treatment.  Regarding lung cancer prevention, the NCCN also states that there is still uncertainty regarding the appropriate duration of lung screening.

In December 2013, the USPSTF released a revised version of their recommendations. In this document, it stated:

‘The USPSTF recommends annual screening for lung cancer with low-dose
computed tomography (CT) in adults aged 55 to 80 years who have a 30 pack-year
smoking history and currently smoke or have quit within the past 15 years.
Screening should be discontinued once a person has not smoked for 15 years
or develops a health problem that substantially limits life expectancy or
the ability or willingness to have curative lung surgery (B recommendation).’

Next week I’m going to have a CT scan to find out if I’m claustrophobic or not.

2.2.3 When is CT Screening Investigational and Not Medically Necessary

The use of LDCT as a screening technique for lung cancer in asymptomatic individuals is considered to be ‘investigational’ and ‘not medically necessary’ when the above criteria, 1 to 5, are not met, and for all other indications.

2.3 Special Populations and Lung Cancer Screening

An outpatient unit or an imaging center will carry out the CT scans for screening for lung cancer.  However, there are patient factors that may lead clinicians to conduct the imaging in a hospital setting.

In 2013, the American Association for Thoracic Surgery (AATS) created a multi-speciality task force to create screening guidelines for groups at high risk of developing lung cancer and survivors of previous lung cancer.

Why for lung cancer prevention is it important to have yearly screening if you meet the criteria?

Like all cancers, Jess, the earlier we can detect lung cancer the better the chances for a complete recovery.

2.3.1 Screening Recommendations for Lung Cancer Survivors

Long-term lung cancer survivors should have annual LDCT, to detect second primary lung cancer, until the age of 79 years.  Annual LDCT lung cancer screening is offered, commencing at age 50 years and those with a 20 pack-year history but if there is an additional cumulative risk of developing lung cancer of 5% or greater over the following 5 years.

Lung cancer screening requires participation by a subspeciality-qualified team. The American Association for Thoracic Surgery intends to continue engagement with other specialty societies to refine future screening guidelines.

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References:

Menezes RJ, Roberts HC, Paul NS, et al. (2010). Lung cancer screening using low-dose computed tomography in at-risk individuals: the Toronto experience. Lung Cancer. 67(2):177–83. (Retrieved 22^nd Jan 2015): http://www.ncbi.nlm.nih.gov/pubmed/19427055

Kovalchik SA, Tammemagi M, Berg CD, et al. Targeting of low-dose CT screening according to the risk of lung-cancer death. N Engl J Med. 2013; 369(3):245-254. (Retrieved 30th Jan 2015):

More references for this section are on this page..

Patient Information:

American Cancer Society:  Who Should Be Screened for Lung Cancer? (Retrieved 16^th March 2015): http://www.cancer.org/cancer/news/features/who-should-be-screened-for-lung-cancer

USPS Task Force Lung Cancer Screening. (Retrieved 22^nd Jan 2015):  https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening

More patient information for this section is on this page.

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