View all posts

American Cancer Society Issues Guidelines Regarding Lung Cancer Screening

Lung cancer remains the biggest killer among all cancers. Unfortunately, by the time lung cancer leads to symptoms, the cancer is already in advanced stages about 75 percent of the time.

But we can do more in the war against lung cancer. In previous years, multiple studies evaluating the use of screening by chest x-ray (CXR) and sputum cytology did not lead to any improvement in lung cancer deaths. However, evidence from the National Lung Screening Trial (NLST) published in 2011 showed that screening using CT scans led to a 20 percent reduction in deaths from lung cancer. This was the first time that a randomized controlled trial showed a benefit to lung cancer screening, representing a huge step in the fight to catch this disease at an earlier stage – when it may still be curable.

Based on the NLST results, consensus guidelines have been issued from national expert consensus panels including the American Society of Clinical Oncologists (ASCO), National Comprehensive Cancer Network (NCCN), American College of Clinical Pharmacy (ACCP) and American Association for Thoracic Surgery (AATS). These guidelines shape the standard of care offered by clinicians, helping them to appropriately counsel patients regarding the risks and benefits of lung cancer screening.

Most recently, the American Cancer Society recommended that clinicians discuss CT screening with high-risk individuals, based on similar criteria to those used for entry in the NLST. These include patients age 55 to 74, with at least a 30 pack-year history of smoking, who are either currently smoking or have quit within the past 15 years. The guidelines advise clinicians to refer patients to high-volume, high-quality lung cancer treatment and screening centers, where multidisciplinary teams evaluate and manage patients in a similar fashion to the NLST, thereby minimizing the risks and maximizing the benefits offered by this important screening program. The guidelines also emphasize the importance of counseling about smoking cessation since such an intervention is the most significant way in which current smokers can reduce their risk for lung cancer, other cancers, and cardiovascular disease at large.

(CA Cancer J Clin 2013; 63; 106-117)

Trends in Smoking Related Deaths by Dr. Mary Daly, medical oncologist, Fox Chase Cancer Center