The benefits of screening high-risk populations for lung cancer with low-dose CT outweigh the harms if screening is implemented in a controlled manner, according to researchers in Canada.
Heidi C. Roberts, MD, of the department of medical imaging at the University of Toronto, and colleagues examined evidence from a recently completed systematic review by the American Cancer Society, the American College of Chest Physicians, ASCO and the National Comprehensive Cancer Network.
The key recommendations include:
- Screening for lung cancer with low-dose CT is recommended in high-risk populations, defined as adults aged 55 to 74 years with a minimum smoking history of 30 pack-years or more.
- Screening for lung cancer should be performed using a low-dose CT multidetector scanner with the following parameters: 120 kVp to 140 kVp, 20 mAs to 60 mAs, with an average effective dose of 1.5 mSv or less.
- A nodule size of ≥5 mm found on the low-dose CT indicates a positive result and warrants a 3-month follow-up CT. Nodules of ≥15 mm should undergo immediate further diagnostic procedures to rule out definitive malignancy.
- Follow-up CT of a nodule should be performed at 3 months as a limited low-dose CT scan
- Patients at high risk for lung cancer should commence screening with an initial low-dose CT scan followed by annual screens for 2 consecutive years, followed by once every 2 years after each negative scan.
Here’s the perspective of Peter Mazzone, MD, MPH, FCCP (Director, Lung Cancer Program Respiratory Institute, Cleveland Clinic):
The latest lung cancer screening guideline from the Cancer Care Ontario’s Program in Evidence-Based Care used a prior systematic review as the evidence base to develop recommendations. Several key recommendations were similar to other published guidelines, inlcuding the definition of the high-risk group to screen (aged 55-74 years, 30 pack-years minimum, smoked within the past 15 years) as well as the need to screen within a formal program capable of providing high quality imaging, interpretation and management of imaging findings. Other recommendations provided practical advice where evidence is not available to confirm or refute the approach. For example, 5 mm was suggested as the size of a solid nodule that should be used as the threshold for a positive study; a three-month CT follow-up of positive studies; and annual screening for 3 years to be followed by screening every second year. The latter recommendations can be debated until additional evidence is available.
I’m Dr. Michael Hunter. If you smoke, please consider quitting. If you have already quit, congratulations. Don’t go back. And if you have a significant history of cigarette use, consider getting CT scans to screen for lung cancer. Thanks!
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Reference: Roberts H. J Thorac Oncol. 2013; doi:10.1097/JTO.0b013e31829fd3d5.