Screening for Lung Cancer Recommended by NCCN

Zosia Chustecka

November 04, 2011

November 4, 2011 — The National Comprehensive Cancer Network (NCCN) has come out in favor of lung cancer screening in a new set of guidelines. It recommends the use of helical low-dose computed tomography (CT) screening for select patients at high risk for the disease.

The NCCN is "the first professional organization to perform this comprehensive review and update their recommendations in light of all the evidence," noted Claudia Henschke, MD, principal investigator of the International Early Lung Cancer Action Program, which first reported benefits from low-dose CT scans in 1999.

"We can no longer ignore the proven potential that CT scanning holds for lung cancer: saving lives," she said in a statement.

Last year, the landmark National Lung Screening Trial was halted early after it showed that screening heavy smokers with low-dose CT scans reduced deaths from lung cancer, compared with screening by chest x-rays.

Lung cancer experts heaped praise on the result, but at the same time expressed some concern about how to proceed with this finding in clinical practice. Among the questions that still need to be addressed are who should be screened, how often, what should be done about unclear findings, and how should intervention for patients who turn out not to have lung cancer be minimized. Indeed, at a recent meeting, experts declared that lung cancer screening is "not yet ready for prime time."

Despite these misgivings, some American practices have already gone ahead and are offering lung cancer screening.

Complex and Controversial Topic

According to the new NCCN guidelines, "lung cancer screening with low-dose CT scans is a complex and controversial topic, with inherent risk and benefits."

The document addresses many of the concerns that have been raised about lung cancer screening, and provide:

  • an overview of the risk factors for lung cancer

  • recommendations for selecting high-risk individuals for screening

  • recommendations for the evaluation and follow-up of nodules found during screening

  • discussions about the accuracy of low-dose CT screening protocols and imaging modalities

  • discussions of the benefits and risks of screening.

The guidelines also touch on cost issues, noting that low-dose CT scans are more expensive than many other screening programs. Each low-dose CT scans for lung cancer costs around $300; the cost of a mammogram for breast cancer screening is around $80 to $150.

"As policies for implementing lung cancer screening are designed, a focus on multidisciplinary programs (incorporating primary care doctors, pulmonologists, radiologists, thoracic surgeons, medical oncologists, and pathologists) will be helpful to optimize decision making and to minimize interventions for patients with benign lung disease," according to the guidelines.