Lynn T. Tanoue

Disclosures

Curr Opin Pulm Med. 2016;22(4):327-335. 

In This Article

Abstract and Introduction

Abstract

Purpose of review Lung cancer screening with low-dose chest computed tomography is now recommended for high-risk individuals by the US Preventive Services Task Force. This recommendation was informed by several randomized controlled trials, the largest of which, the National Lung Screening Trial, demonstrated a 20% relative reduction in lung cancer mortality with annual low-dose chest computed tomography compared with chest radiography.

Recent findings The benefit of lung cancer screening must be balanced against potential harms, including a high false-positive rate with consequent further evaluative studies and invasive testing. It is critical that harms be minimized as screening generalizes to the broad community. Informed decision making between providers and patients should include individualized risk assessment, a discussion of both potential benefit and harm, and tobacco treatment. Given the multiple components required for high quality, screening should ideally occur in the context of a multidisciplinary program.

Summary We are in the early days of lung cancer screening, still with much to learn. Ongoing studies are necessary to refine the definition of a positive screen and develop better methods of distinguishing between true positive and false-positive results. Novel approaches, including the development of multicomponent lung cancer biomarkers, will likely inform and improve our future screening practice.

Introduction

Lung cancer is the leading cause of cancer death around the world.[1] In the USA, the 5-year survival rate for lung cancer is 18%.[2] In contrast, 5-year survival rates for breast, colon, and prostate cancers have increased over the past several decades to 91, 65, and more than 99%, respectively.[2] Many factors have contributed to improved survival for these other common cancers, including public health education in recognizing signs of disease, research funding directed at understanding specific cancer biology and developing novel therapies, and implementation of screening for early detection. Although the subject of lung cancer screening continues to generate enormous debate, the reality is that screening interventions for breast, colorectal, and prostate cancers are widely available, accepted, and practiced by the public and general medical community.[3,4] Lung cancer screening, coming relatively late to this process, is being appropriately scrutinized. The US Preventive Services Task Force (USPSTF) currently recommends,'annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability to have curative lung surgery'.[5]

The evidence base supporting the USPSTF recommendation continues to be rigorously examined. Approval of lung cancer screening by the Centers for Medicare and Medicaid Services in 2014 mandated collection of outcomes data, anticipating broader community implementation of screening and a need to prospectively review its efficacy, safety, and cost.[6]

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....