Lung cancer screening
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Lung cancer screening On the Web
American Roentgen Ray Society Images of Lung cancer screening
Lung cancer screening is a strategy used to identify early lung cancer in people, before they develop symptoms. Screening refers to the use of medical tests to detect disease in asymptomatic people. Screening studies for lung cancer have only been done in high risk populations, such as smokers and workers with occupational exposure to certain substances. This is because radiation exposure from screening could actually induce carcinogenesis in a small percentage of screened subjects, so this risk should be mitigated by a (relatively) high prevalence of lung cancer in the population being screened. A pulmonary nodule larger than 5 - 6 mm is considered a positive result for screening with x-ray or computed tomography.
About 50% of smokers meet the criteria of 20 pack years.
Uptake of lung cancer screening is low.
As of 2021, screening for lung cancer is not an implemented quality measure nor reportable.
In 2021, a clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF) recommended screening for lung cancer among smokers and former smokers who are between 50 to 80 years old and who have smoked 20 pack years or more and either continue to smoke or have quit smoking within the past 15 years (grade B recommendation).
MEDICARE requires that screening include counseling for the benefits of screening and smoking cessation.
- In 2013, a clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF) recommended screening for lung cancer among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack years or more and either continue to smoke or have quit smoking within the past 15 years (grade B recommendation).
- The USPSTF guideline was based on a modeling study using data from the National Lung Screening Trial (NLST) and Prostate, Lung, Colorectal, and Ovarian Cancer Screening (PLCO) randomized controlled trials . The modeling study did not include the MILD randomized controlled trial that suggested harm..
- Clinical practice guidelines issued by the American College of Chest Physicians in 2013 recommend: 
- For smokers and former smokers who are between the age of 55 to 74 years and who have smoked for 30 pack years or more and either continue to smoke or have quit within the past 15 years, it was suggested that annual screening with low dose computed tomography (LDCT) should be offered in settings that can deliver the comprehensive care provided to the National Lung Screening Trial (NLST) participants.
- In 2004, a clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF) gave a grade I recommendation indicating that "the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer".
- In 2007, a clinical practice guideline by American College of Chest Physicians recommended not to screen for lung cancer.
The Swenson prediction rule can aid prediction.
Studies of Efficacy
- Regular chest radiography and sputum examination programs were not effective in reducing mortality from lung cancer.
- Earlier studies (Mayo Lung Project and Czechoslovakia lung cancer screening study, combining over 17,000 smokers) showed that earlier detection of lung cancer was possible but without any improvement in mortality.
- At present, no professional or specialty organization advocates screening for lung cancer outside of clinical trials.
- A computed tomography (CT) scan can uncover tumors not yet visible on an X-ray.
- CT scanning is now being actively evaluated as a screening tool for lung cancer in high risk patients, and it is showing promising results.
- The USA-based National Cancer Institute is currently completing a randomized trial comparing CT scans with chest radiographs. Several single-institution trials are ongoing around the world.
- The International Early Lung Cancer Action Project is a cohort study of 31,000 high-risk patients that found benefit from screening.
- In this study 85% of the 484 detected lung cancers were stage I and thus highly treatable. Mathematically, these stage I patients would have an expected 10-year survival of 88%. However, there was no randomization of patients (all received CT scans and there was no comparison group receiving only x-rays) and the patients were not actually followed up to 10 years post detection (the median follow up was 40 months).
- A cohort of 3,200 current or former smokers found no benefit. These patients were screened for 4 years and offered 3 or 4 CT scans. Lung cancer diagnoses were 3 times as high, and surgeries were 10 times as high, as predicted by a model, but there were no significant differences between observed and expected numbers of advanced cancers or deaths.
- The National Lung Screening Trial (NLST) reported reduction in the diagnosis of advanced-stage cancers.
- The DANTE trial has been inconclusive.
Screening for Lung Cancer U.S. Preventive Services Task Force Recommendation Statement 2013 (DO NOT EDIT)
|"1. The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) 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. (Grade B)"|
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