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{{Non small cell lung cancer}}
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==Overview==
==Overview==
The [[USPSTF|U.S. Preventive Services Task Force (USPSTF)]] recommends annual screening for [[lung cancer]] by [[Computed tomography|low-dose computed tomography]]. The screening test is recommended to the [[Smoking|smokers]] who are between 55 to 80 years old and who have a history of [[smoking]] 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).


==Screening==
==Screening==
===Current Guidelines===
According to the [[United states preventive services task force recommendations scheme|U.S. Preventive Services Task Force (USPSTF)]], screening for [[lung cancer]] by [[Computed tomography|low-dose computed tomography]] is recommended every year among smokers who are between 55 to 80 years old and who have history of [[Smoking|smoke]] 30 pack-years or more and either continue to [[Smoking|smoke]] or have quit within the past 15 years (grade B recommendation).<ref name="“lung">Lung Cancer: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016 </ref><ref name="“JAMA”">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref>
* In 2013, a clinical practice guideline by the U.S. Preventive Services Task Force ([[USPSTF]]) recommended screening for lung cancer among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).<ref name="www.uspreventiveservicestaskforce.org">{{Cite web | last =  | first =  | title = http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm | url = http://www.uspreventiveservicestaskforce.org/uspstf13/lungcan/lungcanfinalrs.htm | publisher =  | date =  | accessdate = 31 December 2013 }}</ref>
 
* [[Clinical practice guideline]]s issued by the [[American College of Chest Physicians]] in 2013 recommend<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>: "For smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years, we suggest that annual screening with LDCT should be offered in settings that can deliver the comprehensive care provided to NLST participants."
'''Guidelines'''
===Previous Guidelines===
* According to the clinical practice guideline by the [[United states preventive services task force recommendations scheme|U.S. Preventive Services Task Force (USPSTF)]], [[Screening test|screening]] for [[lung cancer]] by [[Computed tomography|low-dose computed tomography]] (LDCT) is recommended every year among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).<ref>Lung Cancer Screening. U.S. Preventive Services Task Force 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening Accessed on December 20, 2015</ref>
* In 2004, a clinical practice guideline by the [http://www.ahrq.gov/clinic/uspstfix.htm U.S. Preventive Services Task Force (USPSTF)] gave a [http://www.ahrq.gov/clinic/3rduspstf/ratings.htm grade I recommendation] indicating that "the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer".<ref name="pmid15126258">{{cite journal |author=U.S. Preventive Services Task Force |title=Lung cancer screening: recommendation statement |journal=Ann. Intern. Med. |volume=140 |issue=9 |pages=738-9 |year=2004 |pmid=15126258 |doi=|url=http://www.annals.org/cgi/content/full/140/9/738}}</ref><ref name="pmid15126259">{{cite journal |author=Humphrey LL, Teutsch S, Johnson M |title=Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: an update for the U.S. Preventive Services Task Force |journal=Ann. Intern. Med. |volume=140 |issue=9 |pages=740-53 |year=2004 |pmid=15126259 |doi=|url=http://www.annals.org/cgi/content/full/140/9/740}}</ref>
 
* According to the [[clinical practice guideline]] issued by the [[American College of Chest Physicians]] (CHEST) in 2013, [[Lung cancer screening|screening for lung cancer]] by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years 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'''
*'''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>
** Pros:
*** There is evidence that screening persons aged 55 to 74 years who have cigarette [[smoking]] histories of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years reduce [[lung cancer]] [[Mortality rate|mortality]] by 20% and all-cause [[Mortality rate|mortality]] by 6.7%.
** Cons:
***The majority of all positive [[Computed tomography|low-dose helical computed tomography]] [[Screening test|screening]] exams do not result in a [[lung cancer]] diagnosis. [[False-positive]] exams may result in unnecessary [[Non small cell lung cancer diagnostic study of choice|invasive diagnostic procedures]].
 
*'''Chest x-ray and/or sputum cytology''':<ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref>
**Pros:
***[[Screening (medicine)|Screening]] with [[Chest X-ray|chest x-ray]] and/or [[sputum cytology]] does not reduce [[Mortality rate|mortality]] from [[lung cancer]] in the general population or in ever-smokers.
**Cons:
***[[False positive]] exams
***The majority of all positive [[Chest X-ray|chest x-ray]] [[Screening (medicine)|screening]] exams do not result in a [[Lung cancer|lung cance]]<nowiki/>r diagnosis.
***[[False-positive test result|False-positive]] exams result in unnecessary [[Non small cell lung cancer diagnostic study of choice|invasive diagnostic procedures]].


* In 2007, a [[clinical practice guideline]] by [[American College of Chest Physicians]] recommended not to screen for lung cancer.<ref name="pmid17873156">{{cite journal |author=Alberts WM |title=Diagnosis and Management of Lung Cancer Executive Summary: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) |journal= |volume=132 |issue=3_suppl |pages=1S–19S |year=2007 |pmid=17873156 |doi=10.1378/chest.07-1860}}</ref>
'''Overdiagnosis'''


==Studies of efficacy==
* Based on current evidence, the majority of non-small cell lung cancers detected by [[Screening (medicine)|screening]] [[Chest X-ray|chest x-ray]] and/or [[sputum cytology]] appear to represent [[Overdiagnosis|overdiagnosed]] [[cancer]].<ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref>
Regular chest radiography and sputum examination programs were not effective in reducing mortality from lung cancer.<ref name="pmid14973979">{{cite journal |author=Manser RL, Irving LB, Stone C, Byrnes G, Abramson M, Campbell D |title=Screening for lung cancer |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD001991 |year=2004 |pmid=14973979 |doi=10.1002/14651858.CD001991.pub2}}</ref> Earlier studies (Mayo Lung Project and Czechoslovakia lung cancer screening study, combining over 17,000 smokers) showed earlier detection of lung cancer was possible but mortality was not improved. Simply detecting a tumor at an earlier stage may not necessarily yield improved mortality. For example, plain radiography resulted in increased time from diagnosis of cancer until death and those cancers being detected by screening tended to be earlier stages. However, these patients continued to die at the same rate as those who are not screened. At present, no professional or specialty organization advocates screening for lung cancer outside of clinical trials.
**The magnitude of [[overdiagnosis]] appears to be between 5% and 25%.  
**These [[Cancer|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 natural history, complications and prognosis|smoking-associated comorbidities]] that increase risk propagation.


A computed tomography (CT) scan can uncover tumors not yet visible on an X-ray. CT scanning is now being actively evaluated as a screening tool for lung cancer in high risk patients, and it is showing promising results. The USA-based National Cancer Institute is currently completing a randomized trial comparing CT scans with chest radiographs. Several single-institution trials are ongoing around the world.
==Screening Guidelines==


The International Early Lung Cancer Action Project is a cohort study 31,000 high-risk patients that found benefit from screening.<ref name="pmid17065637">{{cite journal |author=Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, Miettinen OS |title=Survival of patients with stage I lung cancer detected on CT screening |journal=N. Engl. J. Med. |volume=355 |issue=17 |pages=1763-71 |year=2006 |pmid=17065637 |doi=10.1056/NEJMoa060476}}</ref> In this study 85% of the 484 detected lung cancers were stage I and thus highly treatable. Mathematically these stage I patients would have an expected 10-year survival of 88%. However, there was no randomization of patients (all received CT scans and there was no comparison group receiving only x-rays) and the patients were not actually followed out to 10 years post detection (the median followup was 40 months).
*The table below summarizes the screening eligibility for non-small cell lung cancer screening by different organizations.
{| style="border: 5px; font-size: 90%; margin: 5px; width: 1000px" align="center"
! colspan="3" style="padding: 5px 5px; background: #4479BA; font-weight: bold; text-align:center;" |{{fontcolor|#FFF|''' Screening Guidelines for Non Small Cell Lung Cancer''' <br><SMALL>Adapted from Center of Disease Control and Prevention (CDC). 2016 <ref name="CDC"> Screening for non-small cell lung cancer. http://www.cdc.gov/cancer/lung/pdf/guidelines.pdf Accessed on February 22, 2016 </ref></SMALL>}}
| valign="top" |
|+
|-
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Organization}}
! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Groups eligible for screening}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Year}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | American Academy of Family Practice
| style="padding: 5px 5px; background: #F5F5F5;" | Evidence is insufficient to recommend for or against screening
| style="padding: 5px 5px; background: #F5F5F5;" | 2013
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | American Association of Thoracic Surgery
| style="padding: 5px 5px; background: #F5F5F5;" |
1. Age 55 to 79 years with 30 pack year smoking history


A cohort of 3,200 current or former smokers found no benefit. These patients were screened for 4 years and offered 3 or 4 CT scans. Lung cancer diagnoses were 3 times as high, and surgeries were 10 times as high, as predicted by a model, but there were no significant differences between observed and expected numbers of advanced cancers or deaths.<ref name="pmid17341709">{{cite journal |author=Bach PB, Jett JR, Pastorino U, Tockman MS, Swensen SJ, Begg CB |title=Computed tomography screening and lung cancer outcomes |journal=JAMA |volume=297 |issue=9 |pages=953-61 |year=2007 |pmid=17341709 |doi=10.1001/jama.297.9.953}}</ref>
2. Long term lung cancer survivors who have completed 4 years of surveillance without recurrence and who can tolerate lung cancer treatment following screening to detect second primary lung cancer until the age of 79


Subsequent [[randomized controlled trial]]s have been performed or are in progress<ref name="pmid15603850">{{cite journal |author=Gohagan JK, Marcus PM, Fagerstrom RM, ''et al'' |title=Final results of the Lung Screening Study, a randomized feasibility study of spiral CT versus chest X-ray screening for lung cancer |journal=Lung Cancer |volume=47 |issue=1 |pages=9-15 |year=2005 |pmid=15603850 |doi=10.1016/j.lungcan.2004.06.007}}</ref>.
3. Age 50 to 79 years with a 20 pack year smoking history and additional comorbidity that produces a cumulative risk of developing lung cancer ≥ 5% in 5 years
* The National Lung Screening Trial (NLST) reported reduction advanced-stage cancers diagnosed.<ref name="pmid24004119">{{cite journal| author=Aberle DR, DeMello S, Berg CD, Black WC, Brewer B, Church TR et al.| title=Results of the two incidence screenings in the National Lung Screening Trial. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 10 | pages= 920-31 | pmid=24004119 | doi=10.1056/NEJMoa1208962 | pmc=PMC4307922 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24004119  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* The DANTE trial has been inconclusive.<ref name="pmid25760561">{{cite journal| author=Infante M, Cavuto S, Lutman FR, Passera E, Chiarenza M, Chiesa G et al.| title=Long-Term Follow-up Results of the DANTE Trial, a Randomized Study of Lung Cancer Screening with Spiral Computed Tomography. | journal=Am J Respir Crit Care Med | year= 2015 | volume= 191 | issue= 10 | pages= 1166-75 | pmid=25760561 | doi=10.1164/rccm.201408-1475OC | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25760561  }} </ref>
2012
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | American Cancer Society
| style="padding: 5px 5px; background: #F5F5F5;" |
Age 55 to 74 years with ≥30 pack year smoking history, who either currently smoke or have quit within the past 15 years, and who are in relatively good health
| style="padding: 5px 5px; background: #F5F5F5;" |
2015
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | American College of Chest Physicans
| style="padding: 5px 5px; background: #F5F5F5;" |
Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years
| style="padding: 5px 5px; background: #F5F5F5;" |
2013
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | American Society of Clinical Oncology
| style="padding: 5px 5px; background: #F5F5F5;" |
Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years
| style="padding: 5px 5px; background: #F5F5F5;" |
2012
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | American Lung Association
| style="padding: 5px 5px; background: #F5F5F5;" |
Age 55 to 74 years with ≥ 30 pack year smoking history and no history of lung cancer
| style="padding: 5px 5px; background: #F5F5F5;" |
2012
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | Medicaid Services
| style="padding: 5px 5px; background: #F5F5F5;" |
Age 55 to 77 years with ≥ 30 pack year smoking history and smoking cessation < 15 years
| style="padding: 5px 5px; background: #F5F5F5;" |
2015
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | National  Comprehensive  Cancer Network
| style="padding: 5px 5px; background: #F5F5F5;" |
Age 55 to 74 years with ≥30 packyear smoking history and smoking cessation < 15 years OR Age ≥ 50 years and ≥20 pack year smoking history and additional risk factor (other than secondhand smoke exposure
| style="padding: 5px 5px; background: #F5F5F5;" |
2015
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" | U.S Preventive Services Task Force
| style="padding: 5px 5px; background: #F5F5F5;" |
Age 55 to 80 years with ≥30 pack year smoking history and smoking cessation < 15 years
| style="padding: 5px 5px; background: #F5F5F5;" |
2013
|}


==References==
==References==
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Latest revision as of 16:58, 10 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2],Maria Fernanda Villarreal, M.D. [3]

Overview

The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer by low-dose computed tomography. The screening test is recommended to the smokers who are between 55 to 80 years old and who have a history of smoking 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

Screening

According to the U.S. Preventive Services Task Force (USPSTF), screening for 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 smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).[1][2]

Guidelines

Strategies

Overdiagnosis

Screening Guidelines

  • The table below summarizes the screening eligibility for non-small cell lung cancer screening by different organizations.
Screening Guidelines for Non Small Cell Lung Cancer
Adapted from Center of Disease Control and Prevention (CDC). 2016 [7]
Organization Groups eligible for screening Year
American Academy of Family Practice Evidence is insufficient to recommend for or against screening 2013
American Association of Thoracic Surgery

1. Age 55 to 79 years with 30 pack year smoking history

2. Long term lung cancer survivors who have completed 4 years of surveillance without recurrence and who can tolerate lung cancer treatment following screening to detect second primary lung cancer until the age of 79

3. Age 50 to 79 years with a 20 pack year smoking history and additional comorbidity that produces a cumulative risk of developing lung cancer ≥ 5% in 5 years

2012

American Cancer Society

Age 55 to 74 years with ≥30 pack year smoking history, who either currently smoke or have quit within the past 15 years, and who are in relatively good health

2015

American College of Chest Physicans

Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years

2013

American Society of Clinical Oncology

Age 55 to 74 years with ≥30 pack year smoking history,who either currently smoke or have quit within the past 15 years

2012

American Lung Association

Age 55 to 74 years with ≥ 30 pack year smoking history and no history of lung cancer

2012

Medicaid Services

Age 55 to 77 years with ≥ 30 pack year smoking history and smoking cessation < 15 years

2015

National Comprehensive Cancer Network

Age 55 to 74 years with ≥30 packyear smoking history and smoking cessation < 15 years OR Age ≥ 50 years and ≥20 pack year smoking history and additional risk factor (other than secondhand smoke exposure

2015

U.S Preventive Services Task Force

Age 55 to 80 years with ≥30 pack year smoking history and smoking cessation < 15 years

2013

References

  1. ↑ Lung Cancer: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016
  2. ↑ Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
  3. ↑ Lung Cancer Screening. U.S. Preventive Services Task Force 2015. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening Accessed on December 20, 2015
  4. ↑ 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
  5. ↑ Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015
  6. ↑ 6.0 6.1 Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
  7. ↑ Screening for non-small cell lung cancer. http://www.cdc.gov/cancer/lung/pdf/guidelines.pdf Accessed on February 22, 2016


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