Testing It Up

The American College of Chest Physicians (ACCP) has released updated lung cancer guidelines, which recommend offering low-dose computed tomography (LDCT) scanning to people who are at higher risk of developing lung cancer.

“Our new lung cancer guidelines take into account the many advances and new information in the field by providing comprehensive and nuanced recommendations related to prevention, screening, diagnosis, staging, and medical and surgical treatments,” Guideline Panel Chair, W. Michael Alberts, MD, MBA, FCCP, Moffitt Cancer Center, Tampa, FL., said in a news release.

According to ACCP’s guidelines, smokers and former smokers age 55-74 with more than 30 pack-years of smoking should be offered low-dose CT screening. This is a clear change from the 2007 version of the guidelines, in which evidence that showed the importance of CT screening in reducing lung cancer deaths was not yet available.

The guidelines clearly indicated that CT screening should not be given to individuals with less than 30 pack-years of smoking; younger than 55 or older than 74; and those suffering from severe diseases in addition to a primary disease or disorder.

“Lung cancer screening offers a potential benefit for select individuals, but it is not a substitute for stopping smoking,” explained Frank Detterbeck, MD, FCCP, Yale University, New Haven, CT, and Vice-Chair of the Guidelines Panel.

Detterbeck added that the guidelines are also meant to educate both the patient and the physician about the screening in order to overcome misconceptions and misguided fears.

In addition to CT scanning, the guidelines underscore advances in treatment, including the benefits of minimally invasive surgery and treatment at specialized centers.

Three medical groups issued new screening guidelines for lung cancer, published online in the Journal of the American Medical Association.

The guidelines were written by an expert panel, chaired by Peter Bach of the Memorial Sloan-Kettering Cancer Center in New York, for the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network.

The updated guidelines call for annual screenings, but only for current or former heavy smokers, aged 55 to 74. The guidelines indicate that the risks of screening younger or older smokers, or non-smokers, outweigh the benefits that may be derived from these tests.

The screening will consist of low-dose CT scans (a special kind of X-ray that can detect lung cancer early, but may provide false positive results). While regular chest X-rays can also detect lung cancer, these have less detailed images than CT scans. Regular X-rays may also provide false positive results, and have not been proven to save lives. As such, it is not recommended as a screening tool for lung cancer.

There is a possibility that widespread screening may result in some deaths, as abnormal results are usually followed by biopsies and other invasive tests that may prove to be fatal. The number of lives, however, that may be saved from death due to lung cancer by these screenings far outnumber these deaths.

Otis Brawley, chief medical officer at the American Cancer Society, shared: “Screening is a double-edged sword.” While CT cancer screening was able to prevent 80 lung cancer deaths among participants in a study conducted by the National Cancer Institute, 16 participants died after screening, six of whom did not have lung cancer.