Proposed tips prone to establish extra early lung cancers – . Well being Weblog

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

I will never forget to meet new advanced-stage lung cancer patients who wonder if somehow their diagnosis could have been made earlier if the treatment was more likely to have been successful. When I started practicing chest oncology in 2009, there were no approved screening tests for lung cancer.

A Brief History of Lung Cancer Screening

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

Since the NLST publication, an additional randomized clinical trial in Europe (the NELSON study published in the New England Journal of Medicine in February 2020) also showed reductions in lung cancer mortality associated with screening younger patients (ages 50 to 74) and with a lower smoking history in the pack year. Based on this study and other model information, the USPSTF issued a draft recommendation in July 2020 to change the current guidelines for lung screening to require people aged 50 to 80, as well as current and former smokers, to smoke with at least 20 packs per year . For former smokers, the criterion of screening suitability remains a termination date within the last 15 years. The USPSTF estimates that following the proposed guideline could result in a 13% higher reduction in lung cancer deaths than the current guideline.

Suggested guidelines could reduce the racial differences associated with screening fitness

The proposed changes not only enhance the benefits of screening by extending screening to younger patients with a lighter history of smoking, but may also help eliminate racial differences in screening eligibility. Blacks in the US have a higher risk of lung cancer compared to whites, and this risk difference occurs with lower smoke levels. Expanding the screening criteria will allow more people to be screened, but the increase in eligibility will be enriched by non-Hispanic blacks and women.

This is certainly a step in the right direction. It should be noted, however, that the rate of LDCT screening in eligible patients has been low (but is slowly increasing) since the first lung screening guidelines were approved six years ago. I hope that with the expanded eligibility criteria for lung screening we can try again to screen all eligible patients and continue the necessary training of doctors and patients to include lung screening in routine health care.

Weigh the risks and benefits of lung cancer screening

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

There are other risks to consider. For example, there is the possibility of false positive results during screening, which can lead to unnecessary scans or even biopsies or operations. Biopsy or surgery for a non-cancerous condition is rare, but it can happen. Occasionally, complications can arise during a procedure. It is important to understand the risks before you begin screening.

Advances in lung cancer screening have resulted in an earlier diagnosis

I look forward to the day we can significantly reduce lung cancer deaths in the US and around the world. Now when I see patients with positive LDCT screens, I tell them how lucky we are to have found cancer early, when we have a good chance of recovery. Every time I deliver this news, I smile and think of the progress made over the past 10 years. I am preparing to accelerate the momentum into the next decade and beyond.

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