(ChemotherapyAdvisor) – Individuals at increased risk for lung cancer may benefit from low-dose computed tomography (LDCT) screening, a new evidence-based clinical guideline recommends; however, uncertainty exists about potential harms of screening and generalizability of the results, according to an article in JAMA published online May 20.
The systematic review of research into lung-cancer screening represents a collaborative initiative of the American College of Chest Physicians, the American Society of Clinical Oncology, the American Cancer Society, and the National Comprehensive Cancer Network, with input from the American Thoracic Society (ATS), and forms the basis of clinical-practice guidelines developed by ACCP and ASCO, which are endorsed by the ATS.
Of 591 citations identified and reviewed during the literature search, 8 randomized trials and 13 cohort studies of LDCT screening met criteria for inclusion. The most informative randomized study was the National Lung Screening Trial, which found screening resulted in a 20% lower relative risk of death.
The guideline recommendations specifically address CT screening for lung cancer in high-risk individuals who are smokers or former smokers:
Recommendation 1: For smokers and former smokers ages 55 to 74 years who have smoked for 30 pack-years (number of packs of cigarettes smoked per day by the number of years the person has smoked) or more and either continue to smoke or have quit within the past 15 years, it is suggested that annual screening with LDCT should be offered over both annual screening with chest radiograph or no screening, but only in settings that can deliver the comprehensive care provided to National Lung Screening Trial participants. (Grade of evidence 2B, indicating a “weak recommendation based on moderate quality research data.”)
Recommendation 2: For individuals who have accumulated fewer than 30 pack-years of smoking or are either younger than 55 years or older than 74 years, or individuals who quit smoking more than 15 years ago, and for individuals with severe comorbidities that would preclude potentially curative treatment, limit life expectancy, or both, it is suggested that CT screening should not be performed. (Grade of evidence 2C, indicating a “weak recommendation based on low quality research data.”)
“Screening a population of individuals at a substantially elevated risk of lung cancer most likely could be performed in a manner such that the benefits that accrue to a few individuals outweigh the harms that many will experience,” the panel of experts concluded. However, there are substantial uncertainties regarding how to translate that conclusion into clinical practice.”