SCREENING FOR LUNG CANCER

Executive Summary

Background: Magnitude of Problem

• Lung cancer is responsible for more cancer deaths than breast, prostate and colon cancers combined, and the elderly bear a disproportionate share of those deaths.

Successful Lung Cancer Screening Trials

• The improvements in diagnosis and treatment for lung cancer over the past 30 years enabled the NLST trial to detect a decrease in lung cancer deaths through early diagnosis by low-dose computed tomography screening.

Who Should be Screened for Lung Cancer?

• The American Association of Thoracic Surgery (AATS) Lung Cancer Screening and Surveillance Task Force has three main recommendations for required screening groups:
  • –Recommendation 1: smokers and former smokers of 30 or more pack-years should be screened for lung cancer, beginning at the age of 55 years.
    
    – Recommendation 2: long-term cancer survivors should have annual low-dose computed tomography to detect second primary lung cancer until the age of 79 years.
    
    – Recommendation 3: smokers and former smokers of 20 or more pack-years should be screened for lung cancer beginning at the the age of 50 years when additional comorbidities, such as occupational exposures and lung diseases such as emphysema, produce a cumulative risk of developing lung cancer >5% over the following 5 years.

Where Should Lung Cancer Screening Take Place?

• Recommendation 4 of the AATS Lung Cancer Screening and Surveillance Task Force states that institutions with a subspecialty qualified team, including thoracic surgeons, thoracic radiologists, pulmonologists, oncologists and pathologists, should be involved to achieve the minimum morbidity and mortality from treatment for lung cancer seen in the NLST. The NLST trial, which provided the scientific basis for low-dose computed tomography screening for lung cancer, was performed in 33 centers across North America.

Risks of Screening

• There are four main risks of screening. Those risks include radiation exposure, emotional response, cost of screening and overdiagnosis.