Non small cell lung cancer screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]Maria Fernanda Villarreal, M.D. [3]

Overview

According to the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

Screening

According to the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).[1][2][3]

Guidelines

  • According to the clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography (LDCT) is recommended every year 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 within the past 15 years (grade B recommendation).[4]
  • According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, screening for lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years.[5]

Strategies

  • Low-dose helical computed tomography:[6]
  • Benefits
  • There is evidence that screening persons aged 55 to 74 years who have cigarette smoking histories of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years reduce lung cancer mortality by 20% and all-cause mortality by 6.7%.
  • Harms
  • The majority of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis.
  • False-positive exams may result in unnecessary invasive diagnostic procedures.
  • Chest x-ray and/or sputum cytology:[7]
  • Benefits
  • Screening with chest x-ray and/or sputum cytology does not reduce mortality from lung cancer in the general population or in ever-smokers.
  • Harms
  • False positive exams
  • The majority of of all positive chest x-ray screening exams do not result in a lung cancer diagnosis.
  • False-positive exams result in unnecessary invasive diagnostic procedures.

Overdiagnosis

  • Based on current evidence, the majority of non-small cell lung cancers detected by screening chest x-ray and/or sputum cytology appear to represent overdiagnosed cancer.[7]
  • The magnitude of overdiagnosis appears to be between 5% and 25%.
  • These cancers result in unnecessary diagnostic procedures and also lead to unnecessary treatment.
  • Harms of diagnostic procedures and treatment occur most frequently among long-term and/or heavy smokers because of smoking-associated comorbidities that increase risk propagation.

Screening Guidelines

  • The table below summarizes the screening eligibility for non-small cell lung cancer screening by different organizations.
Screening Guidelines for Non Small Cell Lung Cancer
Adapted from Center of Disease Control and Prevention (CDC). 2016 [8]
Organization Groups eligible for screening Year
American Academy of Family Practice Evidence is insufficient to recommend for or against screening 2013
American Association of Thoracic Surgery

1. Age 55 to 79 years with 30 pack year smoking history

2. Long term lung cancer survivors who have completed 4 years of surveillance without recurrence and who can tolerate lung cancer treatment following screening to detect second primary lung cancer until the age of 79

3. Age 50 to 79 years with a 20 pack year smoking history and additional comorbidity that produces a cumulative risk of developing lung cancer ≥ 5% in 5 years

2012

American Cancer Society

Age 55 to 74 years with ≥30 pack year smoking history, who either currently smoke or have quit within the past 15 years, and who are in relatively good health

2015

American College of Chest Physicans

Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years

2013

American Society of Clinical Oncology

Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years

2012

American Lung Association

Age 55 to 74 years with ≥ 30 pack year smoking history and no history of lung cancer

2012

Medicaid Services

Age 55 to 77 years with ≥ 30 pack year smoking history and smoking cessation < 15 years

2015

National Comprehensive Cancer Network

Age 55 to 74 years with ≥30 packyear smoking history and smoking cessation < 15 years OR Age ≥ 50 years and ≥20 pack year smoking history and additional risk factor (other than secondhand smoke exposure

2015

U.S Preventive Services Task Force

Age 55 to 80 years with ≥30 pack year smoking history and smoking cessation < 15 years

2013

References

  1. Lung Cancer: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016
  2. Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
  3. National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016
  4. Lung Cancer Screening. U.S. Preventive Services Task Force 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening Accessed on December 20, 2015
  5. Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB (2013). "Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 143 (5 Suppl): e78S–92S. doi:10.1378/chest.12-2350. PMID 23649455. Summary in JournalWatch
  6. Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015
  7. 7.0 7.1 Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
  8. Screening for non-small cell lung cancer. http://www.cdc.gov/cancer/lung/pdf/guidelines.pdf Accessed on February 22, 2016


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