Chest
Screening for Lung Cancer*: The Guidelines
Section snippets
Background
The rationale for CXR screening is based on the observation that most patients who are diagnosed with lung cancer have advanced stage disease that causes them to have symptoms. In contrast, CXR has sufficient resolution to detect small asymptomatic nodules that are often stage I disease. As stage I lung cancer can be treated through surgery, the efficacy of CXR would be mediated through the detection of lung cancer at an earlier stage, followed by a curative intervention such as removal of the
Background
The rationale for sputum cytology is based on the observation that many individuals have cancerous cells in their sputum at the time of lung cancer diagnosis. Sputum cytology is more sensitive for detecting squamous cell carcinomas, which tend to occur proximally in the bronchial tree, than for adenocarcinomas, which tend to arise more peripherally. Hence, the recent shift in histologic cell type from predominantly squamous cell to predominantly adenocarcinoma, noted in epidemiologic studies,
Background
LDCT scanning is a technique that allows a low-resolution image of the entire thorax to be obtained in a single breath-hold with low radiation exposure. The test is very sensitive, and is capable of routinely detecting nodules as small as 2 to 3 mm in their greatest diameter. In addition, data obtained through LDCT and standard CT scans can be used to reconstruct three-dimensional images that can be assessed sequentially for evidence of growth. The rationale for LDCT as an improved early
Conclusion
The most effective treatment for lung cancer remains surgical resection of early stage disease; however, sporadic lung cancer is rarely diagnosed in its earliest stages. The promise of screening techniques for increasing rates of early stage lung cancer detection, and thus the expectation of more treatable cases, has driven considerable research and ongoing development of screening technologies. RCTs of CXR and sputum cytology have failed to demonstrate a mortality benefit for either technique,
Recommendations
- 1.
For individuals without symptoms or a history of cancer, we recommend against the use of serial CXRs to screen for the presence of lung cancer. Level of evidence, good; benefit, none or negative; grade of recommendation, D
- 2.
For individuals without either symptoms or a history of cancer, we recommend against the use of single or serial sputum cytologic evaluation to screen for the presence of lung cancer. Level of evidence, fair; benefit, none or negative; grade of recommendation, D
- 3.
For individuals
References (19)
- et al.
Design of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial
Control Clin Trials
(2000) - et al.
Sputum screening by quantitative microscopy: a new dawn for detection of lung cancer?
Mayo Clin Proc
(1997) - et al.
Sputum screening by quantitative microscopy: a reexamination of a portion of the National Cancer Institute Cooperative Early Lung Cancer Study
Mayo Clin Proc
(1997) - et al.
Lung cancer surgical practice guidelines: Society of Surgical Oncology practice guidelines
Oncology
(1997) Screening for lung cancer. HCHP Adult Screening and Prevention Task Force. Harvard Community Health Plan Clinical Guidelines and Algorithms
(1989)- et al.
American Cancer Society guidelines for the early detection of cancer: update of early detection guidelines for prostate, colorectal, and endometrial cancers. Also: update 2001; testing for early lung cancer detection
CA Cancer J Clin
(2001) Screening for lung cancer (PDQ). National Cancer Institute CancerNet Web site
Screening for lung cancer United States Preventive Services Task Force ed. Guide to clinical preventive services
(1996)- et al.
A consensus statement of the Society of Thoracic Radiology: screening for lung cancer with helical computed tomography
J Thorac Imaging
(2001)
Cited by (83)
Screening for lung cancer: Diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines
2013, ChestCitation Excerpt :Furthermore, the compliance in these studies was generally only about 60%. Of note, these studies were not designed to assess screening vs no screening because they did not have a true observation-only arm.7,8 Since 2002, only one additional RCT has been conducted (the Prostate, Lung, Colorectal and Ovarian trial [PLCO]), and the results with respect to CXR screening for lung cancer were recently reported.9
Analytical methods based on exhaled breath for early detection of lung cancer
2012, TrAC - Trends in Analytical ChemistryThe Future of Cancer Screening
2009, Primary Care - Clinics in Office PracticeDesign, recruitment and baseline results of the ITALUNG trial for lung cancer screening with low-dose CT
2009, Lung CancerCitation Excerpt :The increased survival demonstrated by observational studies is not sufficient to prove the efficacy of lung cancer screening with low-dose CT. In fact survival is influenced by lead time and length bias and overdiagnosis [7,19]. Only RCTs which are not affected by these confounders can reveal a real benefit of screening in terms of mortality reduction by comparing occurrence of the disease and mortality in the active and control group [7,19].
Cancer Screening in Men
2008, Revista Espanola de Cirugia Ortopedica y TraumatologiaLung cancer: Low-dose helical computed tomography
2008, Cancer Imaging
Department of Community and Family Medicine, Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH.