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Guidelines recommend low-dose CT screening in high-risk populations
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The benefits of screening high-risk populations for lung cancer with low-dose CT outweigh the harms if screening is implemented in a controlled manner, according to researchers in Canada.
“Guidelines on the appropriate use of low-dose CT for lung cancer screening are urgently needed for physicians and patients to avoid the ad hoc adoption of low-dose CT screening for lung cancer by hospitals and diagnostic centers and to minimize the risks associated with low-dose CT scanning,” Heidi C. Roberts, MD, of the department of medical imaging at the University of Toronto, and colleagues wrote.
Roberts and colleagues examined evidence from a recently completed systematic review by the American Cancer Society, the American College of Chest Physicians, ASCO and the National Comprehensive Cancer Network.
Evidence from the collaborative systematic review formed the foundation of the recommendations. Clinical experts in medical and radiation oncology, radiology, lung disease and population health reviewed the recommendations and amended them using the methods of Cancer Care Ontario’s Program in Evidence-Based Care.
Although the practice guideline recommendations generally support the parameters set by the National Lung Screening Study, some variations were deemed necessary by the guideline working group.
The key recommendations include:
- Screening for lung cancer with low-dose CT is recommended in high-risk populations, defined as adults aged 55 to 74 years with a minimum smoking history of 30 pack-years or more.
- Screening for lung cancer should be performed using a low-dose CT multidetector scanner with the following parameters: 120 kVp to 140 kVp, 20 mAs to 60 mAs, with an average effective dose of 1.5 mSv or less.
- A nodule size of ≥5 mm found on the low-dose CT indicates a positive result and warrants a 3-month follow-up CT. Nodules of ≥15 mm should undergo immediate further diagnostic procedures to rule out definitive malignancy.
- Follow-up CT of a nodule should be performed at 3 months as a limited low-dose CT scan
- Patients at high risk for lung cancer should commence screening with an initial low-dose CT scan followed by annual screens for 2 consecutive years, followed by once every 2 years after each negative scan.
“Lung cancer screening with low-dose CT is recommended and can be most effectively and safely offered through an organized screening program and administered by specialized centers with multidisciplinary care teams,” Roberts and colleagues wrote. “To determine whether or not a population-based screening program is appropriate for Ontario will require the CCO Prevention and Cancer Control division to investigate the other criteria relevant to the decision-making process. Priorities will include long-term safety and effectiveness, cost effectiveness, and available resources.”
Perspective
Back to TopPeter Mazzone, MD, MPH, FCCP
The latest lung cancer screening guideline from the Cancer Care Ontario’s Program in Evidence-Based Care used a prior systematic review as the evidence base to develop recommendations. Several key recommendations were similar to other published guidelines, inlcuding the definition of the high-risk group to screen (aged 55-74 years, 30 pack-years minimum, smoked within the past 15 years) as well as the need to screen within a formal program capable of providing high quality imaging, interpretation and management of imaging findings. Other recommendations provided practical advice where evidence is not available to confirm or refute the approach. For example, 5 mm was suggested as the size of a solid nodule that should be used as the threshold for a positive study; a three-month CT follow-up of positive studies; and annual screening for 3 years to be followed by screening every second year. The latter recommendations can be debated until additional evidence is available.
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