Proposed guidelines likely to identify more early lung cancers – Harvard Health Blog

Lung cancer is the second most common cancer in the United States and the deadliest cancer killer. In 2020, an estimated 135,720 people will die from the disease – more than breast, colon and prostate cancer combined.

I will never forget meeting new patients with advanced lung cancer who ask them if their diagnosis could have been made earlier when treatment would have been more likely to be successful. In 2009, when I started practicing chest oncology, there were no approved screening tests for lung cancer.

A brief history of lung cancer screening

Hope for early detection and prevention of death came in 2011 with the publication of the National Lung Screening Trial (NLST). This was the first randomized clinical trial to show a benefit in lung cancer mortality for lung screening, using annual low dose computed tomography (LDCT) scans for elderly patients with a significant history of smoking. This led to the 2014 US Preventive Services Task Force (USPSTF) recommendation for lung cancer screening. The USPSTF recommended an annual LDCT scan to screen for people who have met certain criteria: a smoking history of 30 pack-years (smoke one pack of cigarettes per day for 30 years or the equivalent amount); be a current smoker or a former smoker who quit within the past 15 years; and aged 55 to 80.

Since the publication of the NLST, an additional randomized clinical trial carried out in Europe (the NELSON trial, published in the New England Journal of Medicine in February 2020) also showed a reduction in lung cancer mortality associated with screening younger patients (aged 50-74) and smoking histories of less than year. Based on this trial and other modeling information, the USPSTF released a draft recommendation in July 2020 to amend current guidelines for lung screening to include people aged 50 to 80, as well as current and former smokers for at least 20 years. the story. For former smokers, the screening eligibility criterion remains a quit date for the past 15 years. The USPSTF estimates that following the proposed guideline could lead to a 13% greater reduction in lung cancer deaths compared to the current guideline.

Proposed guidelines could reduce racial disparities associated with screening eligibility

In addition to amplifying the benefits of screening by expanding screening to younger patients with milder smoking histories, the proposed changes may also help eliminate racial disparities in screening eligibility. Blacks in the United States have a higher risk of lung cancer than whites, and this difference in risk occurs at lower smoking levels. By expanding the selection criteria, more people are eligible for screening, but increases in eligibility are enriched among blacks and non-Hispanic women.

It is certainly a step in the right direction. But it’s worth noting that the LDCT screening rate of eligible patients has been low (but slowly increasing) since the initial lung screening guidelines were approved six years ago. My hope with the expanded eligibility criteria for lung screening is that we can renew the pressure to screen all eligible patients and continue the necessary training of physicians and patients to integrate lung screening into routine health care.

Weighing the risks and benefits of screening for lung cancer

When I talk to colleagues and patients about lung cancer screening, one of the most common questions I get is about the downsides of screening and how to assess the risks and benefits. My response is to consider their willingness to undergo curative treatment such as lung surgery or radiation therapy. Fortunately, there are now several treatment options available for most patients with lung cancer.

There are other risks to consider. For example, screening carries the possibility of false positive results which may lead to unnecessary scans, even biopsies or surgery. A biopsy or surgery for what turns out to be a non-cancerous disease is a rare event, but it can happen. In addition, on occasion, a procedure can be complicated. It is important to know the risks before starting the selection process.

Advances in lung cancer screening have led to earlier diagnosis

I look forward to the day when we dramatically reduce lung cancer deaths in the United States and around the world. Now when I see patients with positive LDCT tests I tell them how lucky we are to have found cancer early, when we have a good chance of a cure. Every time I deliver this news, I smile and think about the progress of the past 10 years, and prepare to accelerate the momentum of the next decade and beyond.

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Jothi Venkat

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