US Task Force Makes Recommendations for Lung Cancer ScreeningJul 30, 2013
The United States Preventive Services Task Force (USPSTF) has issued a draft statement recommending that certain people at high risk for lung cancer get a low-dose CT scan every year. The task force is an independent panel of experts authorized by Congress to make recommendations about specific preventive services for patients with no signs or symptoms of disease.
The draft recommendation is for people who are current smokers (or have quit within the last 15 years) aged 55 to 79 years old who have a smoking history of 30 pack-years or greater. A “pack-year” means that someone has smoked an average of 1 pack of cigarettes per day for a year. For example, a person who has smoked a pack a day for 30 years has a 30 pack-year history of smoking, as does a person who smoked 2 packs a day for 15 years.
American Cancer Society chief medical officer Otis W. Brawley, MD, notes the new recommendation takes into account both the harms and benefits of using CT scans for lung cancer screening. "This draft recommendation recognizes that low-dose spiral CT almost certainly saves lives when done on individuals at high risk for lung cancer, based on age and smoking history. It also recognizes that there are harms associated with spiral CT lung cancer screening. “
A little over a year ago, the American Cancer Society published lung cancer screening guidelines based on the National Lung Screening Trial (NLST) and other studies that looked at low-dose CT screening. The guidelines recommend doctors discuss low-dose CT with patients at high risk for lung cancer—those who meet the same criteria used in the NLST study.
The criteria are in place to balance the benefits and risks of screening. Low-dose CT, like other screening tests, can potentially find cancer early, when it’s easier to treat. But the scans also find a lot of abnormalities that eventually turn out not to be cancer. Checking them out may lead to additional scans, more-invasive tests, or even surgery that sometimes harms people who didn’t have cancer in the first place. These risks may outweigh the benefit of screening for everyone except those at higher than average risk for lung cancer, such as heavy smokers.
Brawley said, “One notable difference between the USPSTF draft recommendation and the ACS guidelines is the high emphasis the ACS places on informed decision making about the benefits and harms associated with screening for lung cancer; in particular, the high likelihood of false positive test results on the initial screening test that will require additional follow-up. In contrast, the USPSTF endorses shared decision making only for eligible individuals who have significant health issues. It's important to remember that this is a draft recommendation, and that and other aspects of the recommendation could change in the final version.”
The USPSTF draft statement is open for public comment until August 26. The final recommendation will be important in that it will help determine insurance coverage for screening through Medicare and private insurers. Most insurers do not cover the costs of screening at this time.
Screening, however, is not a substitute for quitting smoking. The most effective way anyone can reduce their risk of lung cancer is to avoid tobacco. If you smoke and want help quitting, see the American Cancer Society Guide to Quitting Smoking or call us at 1-800-227-2345.