New Lung Cancer Screening Guidelines Finalized

Lung cancer screening recommendations finalized by USPSTF

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) A person’s risk of lung cancer plummets after kicking the cigarette habit. Unfortunately, the remaining risk isn’t zero. So, who should be screened for lung cancer and how often should they be screened?

The US Preventive Services Task Force (USPSTF) has issued its final recommendations on lung cancer screening.

People between the ages of 55 and 80 who are or have been heavy smokers should be screened for lung cancer every year, according to the new USPSTF recommendations.

A heavy smoker is someone who has smoked the equivalent of 30 pack-years, which is a pack a day for 30 years or two packs a day for 15 years.

These guidelines apply to current smokers and individuals who have quit within the past 15 years.

Such screening programs, using low-dose computed tomography (CT), could reduce lung cancer-related deaths by 14 percent, the scientists estimated.

"If you’ve ever smoked, talk to your doctor about lung cancer screenings."

The USPSTF recommendations are based on an extensive review and analysis of existing evidence and from modeling studies used to forecast the benefits and harms of various screening scenarios.

Harry J. de Koning, MD, PhD, a physician scientist in the Department of Public Health at the Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues conducted the review and modeling studies.

The researchers relied on data from the National Lung Screening Trial; the Prostate, Lung, Colorectal, and Ovarian trial; the Surveillance, Epidemiology, and End Results database (SEER); and the US Smoking History Generator.

Americans born in 1950 made up the group of individuals who were studied and followed between the ages of 45 and 90.

To develop the most effective guidelines and screening intervals, these researchers analyzed 576 different screening scenarios, which looked at various factors — age, pack-years smoked and years since quitting.

“The most advantageous strategy was annual screening from ages 55 through 80 years for ever-smokers with a smoking history of at least 30 pack-years and ex-smokers with less than 15 years since quitting,” the authors wrote.

Using five different models, the researchers estimated that this low-dose CT screening program would lead to 50 percent of all lung cancer cases being diagnosed in the earliest and most treatable stages (stage l/ll), and would reduce lung cancer-related deaths by 14 percent.

The harms would include false-positive results, which indicate the presence of cancer when there is none, which in turn would lead to unnecessary biopsies or surgeries and a slight (3.7 percent) overdiagnosis of lung cancer, which is defined as the diagnosis and treatment of a cancer that would likely never be life-threatening.

The American College of Radiology (ACR) issued a statement supporting the USPSTF recommendations. “The ACR supports the USPSTF’s recommendation and we are working to complete practice guidelines that cover how lung cancer screening CT exams are performed, interpreted and results communicated,” said Ella A. Kazerooni, MD, chair of the American College of Radiology Thoracic Imaging Panel and Committee on Lung Cancer Screening.

Additionally, the ACR is developing a lung image database, structured reporting and management recommendations similar to those used for breast mammography screening.

“These materials will help ensure that those who should be screened can be tested regardless of where they live and provide for a robust screening program that can help save as many lives as possible,” Dr. Kazerooni added.

The comparative modeling study conducted by Dr. de Koning and team and the full USPSTF recommendation statement were published December 31 in the Annals of Internal Medicine.

The National Cancer Institute funded the research.

Review Date: 
December 31, 2013
Last Updated:
January 2, 2014