American Cancer Society recommends informed decision making in lung cancer screening
New guidelines from the American Cancer Society say evidence is sufficient to recommend screening high risk patients for lung cancer with low-dose computed tomography (CT) provided that certain conditions exist:
- The patient is aged 55 to 74 years, has at least a 30–pack-year smoking history, and currently smokes or has quit within the past 15 years.
- The patient has undergone a thorough discussion of the benefits, limitations, and risks of screening.
- The patient can be screened in a setting with experience in lung cancer screening.
Following the announcement of results from the National Lung Cancer Screening Trial (NLST) in late 2010, the American Cancer Society joined with the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network (NCCN) to produce a systematic review of the evidence related to lung cancer screening with low dose CT. The systematic review focused on four key questions: What are the potential benefits of screening individuals at high risk of developing lung cancer using LDCT? What are the potential harms of screening individuals at high risk of developing lung cancer using LDCT? Which groups are likely to benefit or not benefit? And in what setting is screening likely to be effective?
The results of this systematic review were published in the Journal of the American Medical Association in June, 2012, and were used as the basis for these new recommendations, which are being published early online in CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society. (In 2010, the American Cancer Society issued interim guidance to inform referring clinicians and adults at risk for lung cancer while a full guideline was developed.) The report will appear in print in the March/April 2012 issue of the journal.
In the report describing the new guidelines, the authors say: "Findings from the National Cancer Institute's National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives."
They conclude: "At this time, there is sufficient evidence to support screening provided that the patient has undergone a thorough discussion of the benefits, limitations, and risks, and can be screened in a setting with experience in lung cancer screening."
But they caution that more work is needed to fill in existing knowledge gaps related to broadening eligibility for lung cancer screening, to further define early lung cancer detection protocols, and to put in place an infrastructure to support population-based lung cancer screening. "As with other guidelines for cancer screening, we can expect that this initial guideline will be revised as new data become available," write the authors.
As with other cancer screening recommendations, the new lung cancer screening guidance embraces the process of informed and shared decision-making; a thoughtful discussion with a clinician related to the potential benefits, limitations, and harms associated with screening. This discussion should occur before any decision is made to initiate lung cancer screening.
Among the limitations and harms posed by screening are missed cancers, anxiety associated with abnormal results, the need for additional imaging tests and biopsies, investigation of incidental findings not related to the lungs, and exposure to radiation from repeated tests.
The recommendations emphasize that smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, and that screening should not be viewed as an alternative to smoking cessation.
The hope is that the guideline will lead adults at high risk of lung cancer to become informed about the potential to detect lung cancer early, and to be referred to institutions that can deliver high quality services, and that screening will contribute to additional declines in lung cancer mortality. However, the authors caution that the implementation of high quality lung cancer screening in the U.S. poses many challenges. "Whether community based screening for lung cancer with LDCT will exceed or fail to achieve the benefit observed in the NLST could be influenced by many factors, and the answer awaits the results of further observation and research."
Journal reference: Journal of the American Medical Association
Provided by American Cancer Society
- Low-dose CT screening may benefit individuals at increased risk for lung cancer May 20, 2012 | not rated yet | 0
- Asymptomatic often sent for lung cancer screening tests Mar 13, 2012 | not rated yet | 0
- Task force recommends new lung cancer screening guidelines Jun 21, 2012 | not rated yet | 0
- Lung cancer CT scans: Just for older heavy smokers May 20, 2012 | not rated yet | 0
- Study probes why and how patients with lung cancer initially get diagnosed with the disease Dec 21, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Pressure-volume curve: Elastic Recoil Pressure don't make sense
7 hours ago From pressure-volume curve of the lung and chest wall (attached photo), I don't understand why would the elastic recoil pressure of the lung is...
If you became brain-dead, would you want them to pull the plug?
May 17, 2013 I'd want the rest of me to stay alive. Sure it's a lousy way to live but it beats being all-the-way dead. Maybe if I make it 20 years they'll...
MRI bill question
May 15, 2013 Dear PFers, The hospital gave us a $12k bill for one MRI (head with contrast). The people I talked to at the hospital tell me that they do not...
Ratio of Hydrogen of Oxygen in Dessicated Animal Protein
May 13, 2013 As an experiment, for the past few months I've been consuming at least one portion of Jell-O or unflavored Knox gelatin per day. I'm 64, in very...
Alcohol and acetaminophen
May 13, 2013 Edit: sorry for the typo in the title , can't edit I looked around on google quite a bit and it's very hard to find precise information on the...
Marie Curie's leukemia
May 13, 2013 Does anyone know what might be the cause of Marie Curie's cancer
- More from Physics Forums - Medical Sciences
More news stories
A ground-breaking advance in colonoscopy technology signals the future of colorectal care, according to research presented today at Digestive Disease Week(DDW). Additional research focuses on optimizing the minimal withdrawal ...
Cancer 46 minutes ago | not rated yet | 0
(HealthDay)—Concurrent use of two immune checkpoint antibodies—ipilimumab and nivolumab—may be effective for the treatment of advanced melanoma, according to a proof-of-principal study presented in ...
Cancer 19 hours ago | not rated yet | 0
(HealthDay)—The risks of metastasis and death associated with cutaneous squamous cell carcinoma (CSCC) are low, but significant, and risk factors for poor outcome include tumor diameter, invasion beyond ...
Cancer 20 hours ago | not rated yet | 0 |
A new review finds cancer survivors suffer a diverse and complex set of impairments, affecting virtually every organ system. Writing in CA: A Cancer Journal for Clinicians, Julie Silver, M.D., associate professor at Harvar ...
Cancer May 17, 2013 | not rated yet | 0
(AP)—A California doctor has been sentenced to 14 years in federal prison for bilking her patients out of more than $1 million by promising that an herbal supplement could cure late-stage cancer and other diseases.
Cancer May 17, 2013 | not rated yet | 0
An increasing number of U.S. children are experiencing gastrointestinal issues that require interventions to resolve, according to research presented at Digestive Disease Week (DDW).
49 minutes ago | not rated yet | 0 |
Big names in medicine are set to give an upbeat assessment of the war on AIDS on Tuesday, 30 years after French researchers identified the virus that causes the disease.
9 hours ago | 5 / 5 (1) | 0
For combat veterans suffering from post-traumatic stress disorder, 'fear circuitry' in the brain never rests
Chronic trauma can inflict lasting damage to brain regions associated with fear and anxiety. Previous imaging studies of people with post-traumatic stress disorder, or PTSD, have shown that these brain regions can over-or ...
10 hours ago | not rated yet | 0 |
(Medical Xpress)—What if the quality of your work depends more on your focus on the piano keys or canvas or laptop than your musical or painting or computing skills? If target users can be convinced, they ...
21 hours ago | 3.7 / 5 (3) | 0 |
The neural machinery underlying our olfactory sense continues to be an enigma for neuroscience. A recent review in Neuron seeks to expand traditional ideas about how neurons in the olfactory bulb might encode information about ...
20 hours ago | not rated yet | 0 |
In 2008 researchers from the University of Southern Denmark showed that the drug thioridazine, which has previously been used to treat schizophrenia, is also a powerful weapon against antibiotic-resistant bacteria such as ...
18 hours ago | 3.7 / 5 (3) | 0 |