Lung Cancer Screening Recommended for Those Facing Greatest Risks
January 06, 2014
The U.S. Preventive Services Task Force (USPSTF) has issued final recommendations in support of annual lung cancer screening for those facing the highest risk of lung cancer. Screening helps identify cancer at an early stage so it can be successfully treated.
To reach its recommendation, The Task Force reviewed studies on the potential benefits and harms of lung cancer screening, including results from the National Lung Screening Trial (NLST), a decade-long nationwide study of more than 50,000 people. The NLST consisted of three annual screenings, comparing screening with low-dose computed tomography (CT) to screening with a single view chest X-ray. Current or former heavy smokers, ages 55 to 74, enrolled in study centers across the country, including Dartmouth-Hitchcock Medical Center.
The Task Force found that low-dose CT scans more accurately identify early stage cancer than do other screening tests. They also found that many lung cancer deaths can be prevented by screening high-risk people every year. High-risk can be defined as people who:
- are 55 through 80 years old, and
- have a history of heavy smoking, and
- are either current smokers or who have quit within the past 15 years.
The USPSTF made a point to recommend that patients be informed of the benefits and harms of screening and actively participate in the decision to be tested. "This is a huge, significant change," said William Black MD, radiologist, Dartmouth-Hitchcock Medical Center. "Instead of taking an approach that everyone good or bad should be screened across the board, this calls on people to form preferences and have input on the decision." William C. Black, MD, member of Norris Cotton Cancer Center, professor of Radiology and of Community and Family Medicine, The Dartmouth Institute for Health Policy & Clinical Practice and The Geisel School of Medicine at Dartmouth has championed the idea of including decision aids for patients undergoing lung cancer screening. He worked with colleagues to create a patient guide (PDF) that helps people decide whether to be screened with chest CT.
False alarms are among the harms identified by The Task Force. The test can suggest that a person has lung cancer when, in fact, no cancer is present. False alarms cause worry and anxiety and can lead to follow-up tests and surgeries that aren't needed and may pose other risks.
The USPSTF recommendations are consistent with those offered by other professional organizations. The American College of Chest Physicians (ACCP) and American Society of Clinical Oncology (ASCO) jointly published evidence-based practice guidelines in 2012 about who is eligible for lung cancer screening and how and where it should be performed.
Major medical societies recommend annual lung cancer screening be conducted at medical centers with access to multi-disciplinary lung cancer diagnosis and treatment. Since the first scan can lead to other testing, guidelines stress the importance of being screened at a center that has a comprehensive process for the interpretation, evaluation, and treatment of any potential findings, including lung cancer.
Screening is not an alternative to smoking cessation. All current smokers should be counseled on the benefits of smoking cessation. Research suggests that the absolute risks of continuing to smoke are large, and the absolute benefits of cessation also are large.
Current smokers interested in CT screening for lung cancer are encouraged strongly to seek smoking cessation counseling. Dartmouth-Hitchcock provides patients and families with support and tools to quit smoking, including referral to tobacco cessation clinics of anyone over the age of 18 who wants to end their dependence on tobacco.
USPSTF is an independent panel of experts that make recommendations based on evidence of clinical effectiveness. The recommendations are independent of the U.S. Government. Its members are appointed by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality.
For more information on lung cancer screening, a video, and an on-line calculator of pack years, visit cancer.dartmouth/lungscreening
About Norris Cotton Cancer Center at Dartmouth-Hitchcock
Norris Cotton Cancer Center combines advanced cancer research at Dartmouth College and the Geisel School of Medicine at Dartmouth with patient-centered cancer care provided at Dartmouth-Hitchcock regional locations in Manchester, Nashua, and Keene, NH, and St. Johnsbury, VT, and at 12 partner hospitals throughout New Hampshire and Vermont. It is one of 41 centers nationwide to earn the National Cancer Institute's "Comprehensive Cancer Center" designation. Learn more about Norris Cotton Cancer Center research, programs, and clinical trials online at cancer.dartmouth.edu.