Non small cell lung cancer screening

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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).

Guidelines

• According to the clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by 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).

• According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, 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.

Strategies

• Low-dose helical computed tomography:
  • 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 by 20% and all-cause mortality by 6.7%.
  • Cons:
    • The majority of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis. False-positive exams may result in unnecessary invasive diagnostic procedures.

• Chest x-ray and/or sputum cytology:
  • Pros:
    • Screening with chest x-ray and/or sputum cytology does not reduce mortality from lung cancer in the general population or in ever-smokers.
  • Cons:
    • False positive exams
    • The majority of all positive chest x-ray screening exams do not result in a lung cancer diagnosis.
    • False-positive exams result in unnecessary invasive diagnostic procedures.

Overdiagnosis

• Based on current evidence, the majority of non-small cell lung cancers detected by screening chest x-ray and/or sputum cytology appear to represent overdiagnosed cancer.
  • The magnitude of overdiagnosis appears to be between 5% and 25%.
  • These 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-associated comorbidities that increase risk propagation.

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
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

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