ACCP Says Low Dose CT Way to Go for Lung Cancer Screening

The American College of Chest Physicians recently announced a guideline in support of the use of low-dose computed tomography to screen for lung cancer among people with a high risk for the disease.

In the third edition of the guidelines on the diagnosis and management of lung cancer, published in a supplement to the May issue of Chest, the organization provided evidence in support of using LDCT in a structured, organized screening program. This recommendation is a “clear change” from the previous guideline, released when the organization did not have enough evidence to support lung cancer screening with LDCT.

“Our new lung cancer guidelines take into account the many advances and new information in the field by providing comprehensive and nuanced recommendations related to prevention, screening, diagnosis, staging, and medical and surgical treatments,” guideline panel chair, W. Michael Alberts, MD, MBA, FCCP, of Moffitt Cancer Center in Tampa, Fla., said in a press release. “It also showcases the importance of multidisciplinary, team-based care when it comes to effective lung cancer treatment-collaborative decisions based on collective knowledge provide the most comprehensive patient-focused care.”

In contrast to LDCT, the guideline addresses the use of chest radiography and sputum cytology in patients at risk for developing lung cancer saying that neither method is recommended for screening once or at regular intervals.

The guideline recommending LDCT reads:

“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 should be offered over both annual screening with chest radiograph or no screening, but only in settings that can deliver the comprehensive care provided to National Lung Screening Trial participants.”

Patients offered the option of screening for lung cancer using LDCT should be offered counseling discussing the possible benefits and harms to help them decide whether to proceed. It is also important that lung cancer screening be coupled with careful judgment about whether or not LDCT findings warrant observation or intervention.

Finally, the guidelines call for the establishment of a registry designed to help address the large number of unanswered questions that arise as screening is implemented, as well as to clarify frequent misconceptions around lung cancer screening among patients and physicians.

The guideline includes 274 recommendations that incorporate clinical and methodological information related to lung cancer. In addition to information on screening, the guideline includes recommendations on treatment of lung cancer, treatment of tobacco use, symptom management, and palliative care.