Chest
Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines
Section snippets
Summary of Recommendations
3.2.1. In patients at risk for developing lung cancer, screening for lung cancer with chest radiograph (CXR) once or at regular intervals is not recommended (Grade 1A).
Remark: These results should not be interpreted as diminishing the role of CXR in evaluating patients with pulmonary symptoms (an entirely different situation than screening asymptomatic individuals).
3.2.2. In patients at risk for developing lung cancer, screening for lung cancer with sputum cytology at regular intervals is not
Methods
The following questions were selected as being most relevant. All pertain to asymptomatic, otherwise healthy adults with no history of lung cancer who are at an elevated risk for lung cancer (see also Table 1S):
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What is the rate of death from lung cancer (ie, lung cancer mortality) among individuals at elevated risk of lung cancer who undergo screening with LDCT compared with either no screening or screening with another modality?
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What is the rate of death or complications resulting from biopsies
Background—General Issues Related to Screening
There are several aspects about screening for a disease that make assessment of this intervention different from assessment of treatment of a disease. Screening is applied to an asymptomatic healthy population. Because the majority of screened individuals are likely not to have the disease and would go on to live their lives normally if screening were not done, any potential harms resulting from screening are seen in a different light than potential complications of evaluation or treatment in
Screening With CXR or Sputum Analysis
The first edition of the ACCP Lung Cancer Guidelines summarized the data from RCTs using CXR or sputum analysis to screen for lung cancer.7, 8 The present search yielded one new RCT that assessed the value of screening with CXR or sputum,9 three systematic reviews,10, 11, 12 and two repeat publications with updated data.13, 14 These were combined with studies identified in the first edition and in the following analysis.
Two studies analyzed the addition of sputum analysis every 4 months to
Participant Selection
At present, the only population for which there is a demonstrated benefit is that defined by the NLST: smokers with at least 30 pack-years of exposure, who are aged 55 to 74 years, and who quit < 15 years ago. It is important to note that there is demonstration of benefit only for the entire NLST population; the risk of developing lung cancer ranges from about 2% to > 20% over 10 years for individuals at the low or high end of the NLST inclusion criteria, as estimated from risk prediction
Conclusion
Lung cancer is by far the leading cause of cancer deaths mainly because of the high proportion of lung cancers diagnosed in an advanced stage. CXR and sputum analysis have not been of benefit as screening tools for lung cancer. However, there is a great deal of excitement and enthusiasm about LDCT screening, and emerging data from maturing studies show promise for a substantial reduction in advanced stage cancers and, thereby, the reduced number of people dying of lung cancer. A systematic
Acknowledgments
Author contributions: Dr Detterbeck had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Detterbeck: contributed to planning the overall process for development of the article, data analysis, formulation of recommendations, writing, and oversight of the revision of the manuscript during its development.
Dr Naidich: contributed to the review and revisions of the manuscript and recommendations.
Dr Mazzone:
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COI grids reflecting the conflicts of interest that were current as of the date of the conference and voting are posted in the online supplementary materials.
Disclaimer: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://dx.doi.org/10.1378/chest.1435S1.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
Funding/Sponsors: The overall process for the development of these guidelines, including matters pertaining to funding and conflicts of interest, are described in the methodology article.1 The development of this guideline was supported primarily by the American College of Chest Physicians. The lung cancer guidelines conference was supported in part by a grant from the Lung Cancer Research Foundation. The publication and dissemination of the guidelines was supported in part by a 2009 independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.