Chest physicians group opposes CT lung cancer screening

New evidenced-based guidelines from the American College of Chest Physicians recommend against the use of low-dose CT for the general screening of lung cancer.

Published as a supplement to the September issue of Chest, a journal of the ACCP, the guidelines recommended against screening CT after authors found little evidence to show lung cancer screening impacts mortality in patients, including those who are considered at high risk for the disease.

"Even in high-risk populations, currently available research data do not show that lung cancer screening alters mortality outcomes," said Dr. W. Michael Alberts, chair of the ACCP lung cancer guidelines and chief medical officer of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, FL. "We hope that one day we can find a useful and accurate tool for general lung cancer screening, but at this time, the evidence does not support the use of low-dose CT screening."

Due to the lack of supporting evidence, the guidelines recommend against low-dose CT, chest radiographs, and single or serial sputum cytologic evaluation for lung cancer screening for either a general population or smokers and other high-risk patients, except in the context of a well-designed clinical trial.

The guideline developers were also wary of complication risks from biopsies performed on benign lung nodules identified during low-dose CT screening, according to Dr. Gene Colice, vice chair of the ACCP lung cancer guidelines group. He is also director of pulmonary, critical care, and respiratory services at Washington Hospital Center in Washington, DC.

"Nodules are commonly found during screening; however, to determine whether they are cancerous requires additional testing, which is fairly invasive and extensive. This may cause the patient needless risk, both physically and psychologically," he said.

In its second edition, Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines offers 260 recommendations related to lung cancer prevention, screening, diagnosis, staging, and medical and surgical treatments. The guidelines also review complementary and integrative therapy for the prevention and treatment of lung cancer.

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