Advertisement

2013 ACCP Guideline on Screening for Lung Cancer

Guideline Watch |
May 22, 2013

2013 ACCP Guideline on Screening for Lung Cancer

  1. Allan S. Brett, MD

The American College of Chest Physicians recommends screening with low-dose computed tomography — but only in a carefully defined population.

  1. Allan S. Brett, MD

The American College of Chest Physicians has published a new clinical guideline on screening for lung cancer. The key recommendation is:

“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 [low-dose computed tomography] should be offered . . . but only in settings that can deliver the comprehensive care provided to NLST [National Lung Screening Trial] participants.”

This cautious language reflects several points that the guideline addresses in detail. First, because the NLST is the only randomized trial that has shown a mortality benefit (JW Gen Med Jul 14 2011), the authors believe that screening should be limited to people whose age and smoking histories meet the NLST eligibility criteria.

Second, the authors acknowledge the problem of false positives — i.e., CT scans can identify abnormalities that generate additional tests and procedures in people who don't have lung cancer (JW Gen Med May 22 2013). Further evaluation of patients with false-positive scans is costly, potentially anxiety-provoking, and potentially harmful if invasive tests are performed.

Third, the authors are concerned about screening that is done haphazardly in community practice settings. Many patients with benign nodules can be followed without undergoing biopsies, and very few patients with benign nodules should need surgery to establish benignity. When diagnostic surgery is required, video-assisted thoracic surgery is preferable. The authors believe that screening should be done only in centers where expert multidisciplinary management and follow-up are available.

Citation(s):

Reader Comments (2)

mahmoud Physician, Internal Medicine, gaza

your site is very helpful and it is really keeps me updated day by day at ease and convenience
thank you

TE Crump

In the NLST study, the absolute risk reduction for lung cancer mortality in the CT screening group was 0.33%. The false-positive rate for a positive CT scan was 96%. All this in a population that was very high- risk.

Competing interests: None declared

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement