Screen high-risk populations for lung cancer
High-risk adults age 55 to 80 years should receive annual lung cancer screening with low-dose computed tomography (CT). These final recommendations come from the US Preventive Services Task Force (USPSTF).
Heavy smokers or former heavy smokers who have quit within the past 15 years are considered high risk. Smoking is responsible for about 85% of lung cancers in the United States. The risk for developing lung cancer also increases with age, with most lung cancers occurring in people 55 years or older. Though the prognosis for lung cancer is poor, the prognosis is better for early-stage non-small cell lung cancer, which can be treated with surgical resection.
The recommendation is based on comprehensive review of the evidence and the results of modeling studies that predict the benefits and harms of screening programs based on different screening intervals, age ranges, smoking histories, and time since quitting. The recommendation was published in Annals of Internal Medicine (2013; doi:10.7326/M13-2771). Its full text is free to the public and can be viewed at www.annals.org/article.aspx?doi=10.7326/M13-2771. The comparative modeling study can be viewed at www.annals.org/article.aspx?doi=10.7326/M13-2316.
Two commentaries, also published in Annals of Internal Medicine (2013; doi:10.7326/M13-2926; doi:10.7326/M13-2904), accompanied the Task Force recommendations. In the first, Peter B. Bach, MD, MPH, of Memorial Sloan-Kettering Cancer Center in New York, New York, commends the comprehensive and unbiased review of evidence that underlies the Task Force recommendations but expresses concern about the Task Force's reliance on modeling data to fill evidence gaps, especially with regard to the lung cancer screening recommendations.
The authors of a second editorial describe some of the practical issues associated with putting the Task Force recommendations into practice. Of most concern—how patient selection actually occurs—is not addressed in the guidelines. Patients who are interested or should consider CT screening for lung cancer will need to be counseled and referred. The authors wonder if primary care providers have the tools necessary to do this and if the health care system will be willing to support it.