Long-term smokers and former smokers, along with people who have been treated for lung cancer should be screened for lung cancer every year using low-dose computed tomography (LDCT).
"If you smoked for many years, get screened for lung cancer."
These are the new recommendations of a task force of the American Association for Thoracic Surgery. These guidelines are the result of a literature review of scanning usage, clinical trials and best clinical practices.
The task force, made up of thoracic surgeons and radiologists, pulmonologists, medical oncologists and pathologists, recommend the following groups have annual LDCT screening for lung cancer:
- People aged 55-79 who have smoked at least a pack a day for 30 years (30 pack-years) This could also be two packs a day for 15 years.
- People who have beaten lung cancer and are 5 years out of treatment
- Folks under the age of 50 who have smoked 20 pack-years and have other cancer risk factors
- No one should undergo screening if they have other conditions that would make them unable to be treated for lung cancer.
dailyRx spoke to Fred Hirsch, MD, PhD, professor of medicine and pathology at the University of Colorado Cancer Center, about these new guidelines, and he expressed some reservations.
"While the study results are very encouraging and give screening a substantial impact on a huge global health problem, several issues are still to be addressed in future studies."
"The National Lung Screening Trial (NLST) [which involved more than 53,000 people] showed 'false positive' screens in about 95 percent of the screen detected nodules."
This statistic adds significant burdens to both the individual, the health care system and medical care costs, Dr. Hirsch points out.
He told dailyRx in an email that more tests are needed. "Complementary biomarker studies need to be done in order to identify eventual biomarkers, which can be helpful to distinguish between benign and malignant nodules and eventually also to better select the most optimal screening population."
Technology is advancing, as well, Dr. Hirsch said. "New scan technologies have evolved since these studies were initiated, i.e., volumetric analysis of the nodules and some ongoing screening studies are using that."
The authors of this report agree. "The future will bring refinements in screening and one day may make a blood, urine or breath test available. However, at this time and for the first time in medical history, we can say, 'lung cancer screening—the time has come,'" the authors write.
Dr. Hirsch concludes that "many questions still remain to be addressed, and that is done best in controlled studies, which should be encouraged in the future."
These guidelines were published in the July issue of the Journal of Thoracic and Cardiovascular Surgery.
Various authors disclosed a number of financial relationships with commercial enterprises, including Toshiba, Epigenomics, Roche Diagnostics (which manufacturers CT scanning equipment), Oncimmune, Metabolomx, Astellas Canada and Axela/Exceed, Wyeth Pharmaceuticals, Riverain Medical, Biomet and others.