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Task force recommends annual CT screening for long-term smokers, lung cancer survivors
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Smokers, former smokers with a 30 pack-year history of smoking, and long-term lung cancer survivors aged 55 to 79 years should undergo annual low-dose computed tomography lung cancer screening and surveillance, according to a task force established by the American Association for Thoracic Surgery.
Prior studies have demonstrated that low-dose CT screening helped reduce deaths from lung cancer.
The American Association for Thoracic Surgery (AATS) established the Lung Cancer Screening and Surveillance Task Force to review literature regarding CT usage. The literature included screening trials in the United States and Europe, as well as best clinical practices in the United States and Canada.
The task force — which consisted of thoracic surgeons, thoracic radiologists, epidemiologists, medical oncologists, pulmonologists and pathologists — developed six recommendations:
- Smokers and former smokers aged 55 to 79 years who have a 30 pack-year history of smoking should undergo annual lung cancer screening with low-dose CT.
- Long-term lung cancer survivors — defined as those 4 to 5 years post-therapy — should undergo annual low-dose CT until age 79 years to help detect new primary lung cancer.
- Smokers and former smokers aged 50 to 79 years who have a 20 pack-year history of smoking and additional comorbidity that produces a cumulative risk of developing lung cancer of ≥5% over the following 5 years should undergo annual lung cancer screening with low-dose CT.
- A multidisciplinary team should oversee lung cancer screening and treatment of early-stage lung cancer. The team should consist of subspecialty-qualified thoracic surgeons, thoracic radiologists, pulmonologists, oncologists and pathologists.
- A web-based application should be developed that will allow patients to access educational information, assess personal risk of lung cancer, and allow for voluntary anonymous data collection about the population of lung cancer risk.
- The AATS should continue to engage other specialty societies to develop and refine future screening guidelines.
The guidelines are unique, in part, due to the extended screening recommendation for patients up to age 79 years. Other societies only recommend screening up to age 74.
The task force guidelines also are unique in that they address lung cancer survivors, an addendum under which 94 million American would now be eligible for screening.
However, task force members caution that screening should not be performed on patients with conditions that would preclude successful treatment for lung cancer.
“Screening should not be performed for individuals at elevated risk who do not have the physical reserve required for appropriate treatment,” task force members wrote. “Intervention risks are related to performance status, and long-term survival is negatively affected by poor constitution. Performance status and lung function will be used to determine on an individual basis when to stop lung cancer screening. In the future, the use of ablation for early lung cancer may increase treatment potential for elderly patients. Extremely elderly patients who are well may also benefit from continued screening beyond age 79 years on an individual basis.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Nathaniel R. Evans III, MD
The National Lung Screening Trial proved that screening heavy smokers with annual low dose CT scans saves lives. The new AATS guidelines provide a framework for implementing such a program in a “real-world” setting. They recommend including long-term lung cancer survivors in the population to be screened and provide specific management algorithms. Perhaps most importantly, lung cancer screening appears to be at least as cost effective as screening for breast, colon, or cervical cancer.
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