Tuesday, December 31, 2013

National experts publish final lung cancer screening recommendations

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A national panel of experts now recommends annual low-dose CT scans (LDCTs) to reduce lung cancer deaths among high-risk patients.

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This week, the U.S. Preventive Services Task Force published its final recommendation on lung cancer screening based on a comprehensive review of available evidence.

The statement from the national panel of prevention experts calls for annual low-dose CT scans (LDCTs) to detect lung cancer in patients who:

  • are 55 to 80 years old
  • have a 30 "pack year" or greater history of smoking (a "pack year" means that someone has smoked an average of one pack of cigarettes per day for a year)
  • are either current smokers or have quit in the past 15 years

The panel concluded that its recommendation would reduce lung cancer deaths by 14%. Citing smoking as the biggest risk factor for lung cancer (accounting for about 85 percent of cases in the U.S.), the panel stressed that screening is not an alternative to quitting smoking.

"For patients at high risk of lung cancer, screening with LDCT has the potential to find even the smallest cancers at an early stage when they are most treatable," said Jo-Anne Shepard, MD, director of Thoracic Imaging and Intervention in the Mass General Department of Radiology. She added that about 95% of lung nodules are benign and may require an additional CT scan but more concerning ones may require more frequent follow-up or a biopsy.

Evidence for the test's effectiveness comes from large academic medical centers with expertise in using LDCT and diagnosing and managing suspicious lung lesions. According to the panel's statement, the effectiveness of lung cancer screening is associated with clinical settings with high rates of accuracy in interpreting LDCTs, appropriate follow-up protocols for positive results, and clear criteria for undertaking invasive procedures.

LDCT for lung cancer is available at Mass General for patients with a doctor's order who meet the recommended criteria. All scans are interpreted by thoracic radiologists who specialize in lung cancer diagnosis and collaborate with thoracic oncologists, thoracic surgeons and pulmonologists to provide comprehensive follow-up care.

The test, which requires no preparation or injection, uses a low dose of radiation comparable to that of a mammogram and less than the average American's annual exposure to background radiation.

Lung cancer is the leading cause of cancer death in the United States, diagnosed in more than 200,000 Americans each year with a growing number of cases in women. Nearly 90 percent of people who have lung cancer die from the disease because it often goes undetected until it reaches an advanced stage. LDCT is the only recommended screening test for lung cancer.

Physicians can call 617-724-9729 or use ROE to order LDCTs for lung cancer screenings at Mass General Imaging locations in Waltham, Chelsea and Worcester. Currently, the test is available on a self-pay basis for $350. Insurance companies are expected to provide coverage by the end of 2014.

For more information, read the final recommendation statement from U.S. Preventive Services Task Force, published in the Annals of Internal Medicine.

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