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==Overview==
==Overview==


According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected 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).<ref name=“lung screen">Lung Cancer: Screening  http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016 </ref><ref name="“JAMA”">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref><ref name=“ludng">National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016</ref><ref name="US">Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016</ref><ref name="NEJM">McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.</ref>
According to the [[USPSTF|U.S. Preventive Services Task Force (USPSTF)]], screening for suspected [[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).<ref name=“lung screen">Lung Cancer: Screening  http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016 <nowiki></ref></nowiki><ref name="“JAMA”">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref><ref name="“ludng&quot;">National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016</ref><ref name="US">Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016</ref><ref name="NEJM">McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.</ref>


==Screening==
==Screening==
Line 11: Line 11:
'''Guidelines'''
'''Guidelines'''


*According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected 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).<ref name="“JAMA”">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref><ref name="US">Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016</ref><ref name="NEJM">McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.</ref><ref name=“lung screen">Lung Cancer: Screening  http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016 </ref><ref name=“ludng">National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016</ref>
*According to the [[USPSTF|U.S. Preventive Services Task Force (USPSTF]]), screening for suspected [[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).<ref name="“JAMA”">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref><ref name="US">Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016</ref><ref name="NEJM">McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.</ref><ref name=“lung screen">Lung Cancer: Screening  http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016 <nowiki></ref></nowiki><ref name="“ludng&quot;">National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016</ref>


* According to the [[clinical practice guideline]] issued by the [[American College of Chest Physicians]] (CHEST) in 2013, screening for suspected 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.<ref name="pmid23649455">{{cite journal| author=Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB| title=Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2013 | volume= 143 | issue= 5 Suppl | pages= e78S-92S | pmid=23649455 | doi=10.1378/chest.12-2350 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23649455  }} [http://general-medicine.jwatch.org/cgi/content/full/2013/522/2 Summary in JournalWatch]</ref>
* According to the [[clinical practice guideline]] issued by the [[American College of Chest Physicians]] (CHEST) in 2013, screening for suspected [[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.<ref name="pmid23649455">{{cite journal| author=Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB| title=Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. | journal=Chest | year= 2013 | volume= 143 | issue= 5 Suppl | pages= e78S-92S | pmid=23649455 | doi=10.1378/chest.12-2350 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23649455  }} [http://general-medicine.jwatch.org/cgi/content/full/2013/522/2 Summary in JournalWatch]</ref>


'''Strategies'''
'''Strategies'''


* Low-dose helical computed tomography<ref name="lungscreen">Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015</ref>
* Low-dose helical [[computed tomography]]<ref name="lungscreen">Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015</ref>
:* Benefits
:* Benefits
::* 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 reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.
::* 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 reduces [[lung cancer]] [[mortality]] by 20% and all-cause [[mortality]] by 6.7%.


:* Harms
:* Harms
::* The majority of of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis.  
::* The majority of 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.
::* False-positive exams may result in unnecessary invasive diagnostic procedures.


* Chest x-ray <ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref>
* [[Chest X-ray|Chest x-ray]] <ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref>
:*Benefits
:*Benefits
::*Screening with chest x-ray does not reduce mortality from lung cancer in the general population or in ever-smokers.
::*Screening with [[Chest X-ray|chest x-ray]] does not reduce [[mortality]] from [[lung cancer]] in the general population or in ever-smokers.


:* Harms
:* Harms
::* False positive exams
::* False positive exams
::* The majority of of all positive chest x-ray screening exams do not result in a lung cancer diagnosis.  
::* The majority of of all positive [[Chest X-ray|chest x-ray]] [[screening]] exams do not result in a [[lung cancer]] diagnosis.  
::* False-positive exams result in unnecessary invasive diagnostic procedures.
::* False-positive exams result in unnecessary invasive diagnostic procedures.


'''Overdiagnosis'''
'''Overdiagnosis'''


* Based on current evidence, the majority of lung masses detected by screening chest x-ray appear to represent over-diagnosed cancer.<ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref>
* Based on current evidence, the majority of lung mass cases detected by [[screening]] [[chest x-ray]] appear to represent over-diagnosed [[cancer]].<ref name="JAMA">Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.</ref>
*The magnitude of overdiagnosis appears to be between 5% and 25%.  
*The magnitude of [[overdiagnosis]] appears to be between 5% and 25%.  
*These cancers result in unnecessary diagnostic procedures and also lead to unnecessary treatment.  
*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.
*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.


==References==
==References==

Revision as of 15:05, 9 March 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected 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).[1]</nowiki>[2][3][4][5]

Screening

Guidelines

Strategies

  • Benefits
  • 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 reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.
  • Harms
  • The majority of 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.
  • Benefits
  • Harms
  • False positive exams
  • The majority of 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 lung mass cases detected by screening chest x-ray appear to represent over-diagnosed cancer.[8]
  • 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.

References

  1. ↑ 1.0 1.1 Lung Cancer: Screening http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening. Accessed on February 3, 2016 <nowiki>
  2. ↑ 2.0 2.1 Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.
  3. ↑ 3.0 3.1 National Lung Screening Trial. Wikipedia. https://en.wikipedia.org/wiki/National_Lung_Screening_Trial Accessed on February 4,2016
  4. ↑ 4.0 4.1 Recommendations. US preventive services task force(2016) http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=solitary_pulmonary_nodule Accessed on March, 15th 2016
  5. ↑ 5.0 5.1 McWilliams A, Tammemagi MC, Mayo JR, et. al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med. 2013 Sep 5;369(10):910-9. doi:10.1056/NEJMoa1214726.
  6. ↑ Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB (2013). "Screening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 143 (5 Suppl): e78S–92S. doi:10.1378/chest.12-2350. PMID 23649455. Summary in JournalWatch
  7. ↑ Lung Cancer Screening. National Cancer Institute 2015. http://www.cancer.gov/types/lung/hp/lung-screening-pdq Accessed on December 20, 2015
  8. ↑ 8.0 8.1 Davis AM, Cifu AS. Lung Cancer Screening. JAMA. 2014;312(12):1248-1249. doi:10.1001/jama.2014.12272.

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References

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