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Task Force Recommends Lung Cancer Screening for Heavy Smokers

For those at high risk, annual lung cancer screenings with low-dose CT scans might detect cancer early enough for lifesaving treatment

William Black, MD, member of the Norris Cotton Cancer Center and professor of radiology at the Geisel School of Medicine at Dartmouth, and Julianna Czum, MD, director of Cardiac Imaging at Norris Cotton Cancer Center, explain the benefits of CT scanning for lung cancer.

Adults with a history of heavy smoking have a new way to protect themselves from lung cancer. An independent panel of experts says low-dose CT scans save lives by finding lung cancer earlier. The opinion means low-dose CT scans could soon be offered annually to some smokers and former smokers.

The U.S. Preventive Services Task Force (USPSTF) has announced draft recommendations in support of lung cancer screening for those facing the highest risk of lung cancer. The task force draft guidelines recommend annual low-dose CT scans for current smokers (or those who quit in the last 15 years) aged 55-79 years old who have a smoking history of 30 pack years or greater (find your pack years here)

CT scan screening is reversal of past findings on lung cancer

The announcement reverses earlier Task Force recommendations, and follows the release of a technical report produced by the Cancer Intervention and Surveillance Modeling Network (CISNET), a consortium of National Cancer Institute (NCI) sponsored investigators who use statistical modeling to improve public health. In 1996 the Task Force recommended against screening for lung cancer and reached that same conclusion again in 2004. But the new recommendations determined that a reasonable balance of benefits and harms is obtained by annual low dose CT screening for people at highest risk.

NCCC lung cancer screening trial data used to support report

Dartmouth-Hitchcock radiologist William C. Black, MD served as an advisor to the CISNET consortium. Black helped CISNET understand data gathered in a ten-year study he helped design called the National Lung Screening Trial (NLST), which provided much of the data supporting this change in clinical practice.

In addition to helping design the NLST, Black–a member of the Norris Cotton Cancer Center, director of chest imaging at Dartmouth-Hitchcock, and professor of radiology and of community and family medicine at Dartmouth's Geisel School of Medicine–served on its executive committee and was principal investigator for the trial at Dartmouth-Hitchcock Medical Center. Black's firsthand experience as a radiologist who conducted a decade of lung cancer screens allowed him to offer clinical knowledge about the principles of chest radiology to CISNET.

Lung cancer screening at comprehensive medical centers is important

Major medical societies recommend that 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, the guidelines stress the importance of being screened at a center with a comprehensive process for the interpretation, evaluation, and treatment of any potential findings, including lung cancer. Dartmouth-Hitchcock's Lung Cancer Screening service is part of the Norris Cotton Cancer Center at Dartmouth, one of only 41 NCI-designated comprehensive cancer centers

Lung cancer screening is not for everyone: weighing the benefits and harms

The USPSTF recommends that patients actively participate in the decision to be tested, and that they be given information on the benefits and harms of screening. "This is a huge, significant change," said Black. "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."

Development of decision aids and shared decision making

Over the past 2 years, Black has co-chaired the Norris Cotton Cancer Center at Dartmouth's Lung Cancer Screening Working Group. Black championed the idea of including decision aids for patients undergoing lung cancer screening and with the help of fellow Dartmouth researchers Lisa Schwartz, MD, and Steve Woloshin, MD at the Dartmouth Institute for Health Policy & Clinical Practice (TDI) created a patient and physician guide to explain the results of NLST (Patient and Physician Guide: National Lung Screening Trial). They went on to create another guide for Dartmouth-Hitchcock that more specifically focused on the decision about whether to be screened with chest CT (Helping you decide about lung cancer screening) (PDF).

Smoking is still the greatest risk factor for lung cancer

Screening is not an alternative to smoking cessation. According to the National Cancer Institute, smoking accounts for nearly 85 percent of all lung cancer deaths. Current smokers interested in CT screening for lung cancer are encouraged 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.

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August 05, 2013