The US Preventative Service Task Force recommends annual screening for lung cancer with low-dose CT scans for adults ages 55 to 80 who are at high risk for lung cancer because they have smoked a pack or more per day of cigarettes for at least 30 years and currently smoke or have quit within the past 15 years.
The Task Force issued its long-awaited guideline on lung cancer screening this week. It is estimated that this test could eventually prevent between 8,000 and 22,000 lung cancer deaths per year. About 95% of lung cancers are due to cigarette smoking. In the USA, 37% of Americans are current or former smokers, and 20% still smoke.
What is the US Preventative Service Task Force? The task force is an independent group of experts that makes evidence-based recommendations on preventative services such as screening, preventative medications and counseling services. Their process for developing guidelines involves an extensive review of scientific studies. The task force advises the US Department of Health and Human Services. The Affordable Care Act mandates that health insurance cover screenings that the task force deems useful.
Why Now? The latest recommendation is largely based on the National Cancer Institute’s National Lung Screening Trial. This study began in 2001, and is one of the best-designed cancer screening studies ever conducted. The study issued results fairly recently. Other organizations have issued similar recommendations, including the American College of Chest Surgeons, the American Society of Clinical Oncology, the American Thoracic Society, the American Association for Thoracic Surgery, the National Comprehensive Cancer Network, and the American Cancer Society.
What are the results of the NCI National Lung Screening Trial? The study assessed over 54,000 smokers and showed screening caused a 2-% decline in lung cancer deaths eight to ten years later. This means that 80% of lung cancer deaths still occurred.
Are there potential harms from screening? Yes. More than one in four people screened will have a finding that leads to further testing. Ultimately, 24 out of 25 who get further testing will not have lung cancer. Additional testing may include more imaging, as well as invasive tests such as biopsies or even surgery. In fact, in the National Lung Cancer Screening Trial, about one person died after an invasive procedure triggered by screening for every five to six lives saved because of screening.
My take: Low-dose screening studies reduce the risk of death from lung cancer, albeit with the potential costs detailed above. We also need a screening test for non-smokers and light smokers, as about 1 in 6 who get lung cancer are non-smokers. There is not great benefit to low-dose spiral CT screening for this population. Finally, don’t use screening as an excuse to continue smoking, as there is a greater benefit to quitting in general. I’m Dr. Michael Hunter.
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