ACCP Issues New Guidelines for Lung Cancer Screening

Roxanne Nelson

May 07, 2013

New guidelines from the American College of Chest Physicians (ACCP) recommend that patients at a high risk for lung cancer be offered screening.

In their third edition of evidence-based lung cancer guidelines, Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, the ACCP recommends that patients who face a significant risk of developing lung cancer due to age and smoking history be offered low-dose, computed tomography (LDCT) scanning.

These recommendations are based on a systematic review of the data that demonstrates reduction in lung cancer-specific mortality when screening is conducted in an organized program. This is a clear change from the prior edition of the guidelines, released in 2007, when this evidence was not yet available.

The guidelines have been published as a special supplement to the May issue of Chest.

The new guidelines cover evidence to support lung cancer screening in this population, and how it can reduce the mortality from lung cancer deaths among individuals at elevated risk of developing the disease. They also document the advances of the past 5 years in the area of tobacco, including the benefits of smoking cessation in patients who already have lung cancer.

"Our new lung cancer guidelines take into account the many advances and new information in the field by providing comprehensive and nuanced recommendations related to prevention, screening, diagnosis, staging, and medical and surgical treatments," said Guideline Panel Chair, W. Michael Alberts, MD, MBA, FCCP, in a statement.

It also showcases the importance of multidisciplinary, team-based care when it comes to effective lung cancer treatment — collaborative decisions based on collective knowledge provide the most comprehensive patient-focused care," added Dr. Alberts, from Moffitt Cancer Center, Tampa, Florida.

Joins Other Organizations

As previously reported by Medscape Medical News, a growing number of associations and organizations have been publishing updated guidelines that reflect the evidence that supports screening in high-risk groups. For example, the American Cancer Society released updated guidelines earlier this year on lung cancer screening that concluded that there is now sufficient evidence for screening with LDCT in certain high-risk individuals.

The National Comprehensive Cancer Network came out in favor of lung cancer screening in a new set of guidelines, also recommending the use of LDCT in select patients at high risk for the disease. Their guidelines, issued in 2011, made them the first professional organization to perform this comprehensive review and update their recommendations in light of all the evidence.

Complex Interplay

The ACCP guidelines note that lung cancer screening is "a complex interplay of an individual's risk and many other key factors, including how LDCT scanning is performed and interpreted by the team." In addition, there must be an appropriate balance of benefit with concerns associated with lung cancer, radiation, and observation of incidental nodules.

Their guidelines also call for establishing a registry designed to assist in addressing the large number of questions that still remain unanswered, as well as those that will arise as screening is implemented. Additionally, the guidelines call for establishment of quality metrics so that benefits are optimized, and harm is kept low.

"Lung cancer screening offers a potential benefit for select individuals, but it is not a substitute for stopping smoking," said Frank Detterbeck, MD, FCCP, from Yale University, New Haven, Connecticut, and vice-chair of the guidelines panel. "However, screening is not a scan, it is a process."

In a statement, Dr. Detterbeck added that "education on screening is the key to overcoming misconceptions and misguided fears. The guidelines include recommendations that help the patient and physician with the decision process. It provides a structure that gives a clearer interpretation of what we know and what we can only speculate."

Chest. 2013;143(5_suppl):e78S-e92S. Abstract