Lung mass screening: Difference between revisions
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==Overview== | ==Overview== | ||
According to the [[USPSTF|U.S. Preventive Services Task Force (USPSTF)]], screening for suspected [[lung cancer]] by low-dose [[computed tomography]] is recommended every year among smokers who are between 55 to 80 years old and who have history of | According to the [[USPSTF|U.S. Preventive Services Task Force (USPSTF)]], [[Screening (medicine)|screening]] for suspected [[lung cancer]] by low-dose [[computed tomography]] is recommended every year among smokers who are between 55 to 80 years old and who have a history of 30 [[Pack year|pack-years]] or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).<ref name="“JAMA”">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref><ref name="US">Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016</ref><ref name="NEJM">McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.</ref> | ||
==Screening== | ==Screening== | ||
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'''Guidelines''' | '''Guidelines''' | ||
*According to the [[USPSTF|U.S. Preventive Services Task Force (USPSTF]]), screening for suspected [[lung cancer]] by low-dose [[computed tomography]] is recommended every year among smokers who are between 55 to 80 years old and who have history of | *According to the [[USPSTF|U.S. Preventive Services Task Force (USPSTF]]), [[Screening (medicine)|screening]] for suspected [[lung cancer]] by low-dose [[computed tomography]] is recommended every year among smokers who are between 55 to 80 years old and who have a history of 30 [[Pack year|pack-years]] or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).<ref name="“JAMA”">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref><ref name="US">Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016</ref><ref name="NEJM">McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.</ref> | ||
* According to the [[clinical practice guideline]] issued by the [[American College of Chest Physicians]] (CHEST) in 2013, screening for suspected [[lung cancer]] by low-dose [[CT]] (LDCT) is recommended every year among smokers and former smokers who are | * According to the [[clinical practice guideline]] issued by the [[American College of Chest Physicians]] (CHEST) in 2013, [[Screening (medicine)|screening]] for suspected [[lung cancer]] by low-dose [[CT]] (LDCT) is recommended every year among smokers and former smokers who are 55 to 74 years old and who have 30 [[Pack year|pack-years]] history or more and either continue to smoke or have quit within the past 15 years.<ref name="pmid23649455">{{cite journal| author=Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB| title=Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2013 | volume= 143 | issue= 5 Suppl | pages= e78S-92S | pmid=23649455 | doi=10.1378/chest.12-2350 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23649455 }} [http://general-medicine.jwatch.org/cgi/content/full/2013/522/2 Summary in JournalWatch]</ref> | ||
'''Strategies''' | '''Strategies''' | ||
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* Low-dose helical [[computed tomography]]<ref name="lungscreen">Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015</ref> | * Low-dose helical [[computed tomography]]<ref name="lungscreen">Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015</ref> | ||
:* Benefits: | :* Benefits: | ||
::* There is evidence that [[screening]] | ::* There is evidence that [[screening]] people aged 55 to 74 years who have a history of 30 or more [[Pack year|pack-years]] and who, if they are former smokers, have quit within the last 15 years, reduces [[lung cancer]] [[mortality]] by 20% and all-cause [[mortality]] by 6.7%. | ||
:* Harms: | :* Harms: | ||
::* The majority of of all positive low-dose helical [[computed tomography]] screening exams do not result in a [[lung cancer]] diagnosis. | ::* The majority of of all positive low-dose helical [[computed tomography]] [[Screening (medicine)|screening]] exams do not result in a [[lung cancer]] [[diagnosis]]. | ||
::* False-positive | ::* [[False-positive test result|False-positive]] results may lead to unnecessary [[Invasive (medical)|invasive]] [[diagnostic procedures]]. | ||
* [[Chest X-ray|Chest x-ray]] <ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref> | * [[Chest X-ray|Chest x-ray]] <ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref> | ||
:*Benefits: | :*Benefits: | ||
::*Screening with [[Chest X-ray|chest x-ray]] does not reduce [[mortality]] from [[lung cancer]] in the general population or in ever-smokers. | ::*[[Screening (medicine)|Screening]] with [[Chest X-ray|chest x-ray]] does not reduce [[mortality]] from [[lung cancer]] in the general population or in ever-smokers. | ||
:* Harms: | :* Harms: | ||
::* False positive | ::* [[False positive]] results. | ||
::* The majority of of all positive [[Chest X-ray|chest x-ray]] [[screening]] exams do not result in a [[lung cancer]] diagnosis. | ::* The majority of of all positive [[Chest X-ray|chest x-ray]] [[screening]] exams do not result in a [[lung cancer]] [[diagnosis]]. | ||
::* False-positive | ::* [[False-positive test result|False-positive]] results may lead to unnecessary [[Invasive (medical)|invasive]] [[diagnostic procedures]]. | ||
'''Overdiagnosis''' | '''Overdiagnosis''' | ||
* Based on current evidence, the majority of lung mass cases detected by [[screening]] [[chest x-ray]] appear to represent over-diagnosed [[cancer]].<ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref> | * Based on current evidence, the majority of lung mass cases detected by [[screening]] [[chest x-ray]] appear to represent [[Overdiagnosis|over-diagnosed]] [[cancer]].<ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref> | ||
*The magnitude of [[overdiagnosis]] appears to be between 5% and 25%. | *The magnitude of [[overdiagnosis]] appears to be between 5% and 25%. | ||
*These [[cancers]] result in unnecessary diagnostic procedures and also lead to unnecessary treatment. | *These [[cancers]] result in unnecessary [[diagnostic procedures]] and also lead to unnecessary treatment. | ||
*Harms of [[diagnostic]] | *Harms of [[diagnostic procedures]] and treatment occur most frequently among long-term and/or heavy smokers because of smoking-associated comorbidities that increase the risk. | ||
==References== | ==References== | ||
Revision as of 20:27, 18 June 2019
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Lung Mass Microchapters |
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Lung mass screening On the Web |
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American Roentgen Ray Society Images of Lung mass screening |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]
Overview
According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have a history of 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).[1][2][3]
Screening
Guidelines
- According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have a history of 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).[1][2][3]
- According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, screening for suspected lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are 55 to 74 years old and who have 30 pack-years history or more and either continue to smoke or have quit within the past 15 years.[4]
Strategies
- Low-dose helical computed tomography[5]
- Benefits:
- There is evidence that screening people aged 55 to 74 years who have a history of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years, reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.
- Harms:
- The majority of of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis.
- False-positive results may lead to unnecessary invasive diagnostic procedures.
- Benefits:
- Screening with chest x-ray does not reduce mortality from lung cancer in the general population or in ever-smokers.
- Harms:
- False positive results.
- The majority of of all positive chest x-ray screening exams do not result in a lung cancer diagnosis.
- False-positive results may lead to unnecessary invasive diagnostic procedures.
Overdiagnosis
- Based on current evidence, the majority of lung mass cases detected by screening chest x-ray appear to represent over-diagnosed cancer.[6]
- The magnitude of overdiagnosis appears to be between 5% and 25%.
- These cancers result in unnecessary diagnostic procedures and also lead to unnecessary treatment.
- Harms of diagnostic procedures and treatment occur most frequently among long-term and/or heavy smokers because of smoking-associated comorbidities that increase the risk.
References
- ↑ 1.0 1.1 Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
- ↑ 2.0 2.1 Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016
- ↑ 3.0 3.1 McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.
- ↑ Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB (2013). "Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 143 (5 Suppl): e78S–92S. doi:10.1378/chest.12-2350. PMID 23649455. Summary in JournalWatch
- ↑ Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015
- ↑ 6.0 6.1 Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.