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Screening for Lung Cancer: Recommendations from the U.S. Preventive Services Task Force FREE

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This article was published online first at www.annals.org on 31 December 2013.

The full report is titled “Screening for Lung Cancer: U.S. Preventive Services Task Force Recommen-dation Statement.” It is in the 4 March 2014 issue of Annals of Internal Medicine (volume 160, pages 330-338). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.

Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.

Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.

Ann Intern Med. 2014;160(5):I-40. doi:10.7326/P14-9009
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Lung cancer is the most common cause of cancer-related death in the United States. Smoking is the major risk factor for lung cancer. Nearly 90% of people with lung cancerdie of this condition, but some types of lung cancer can be cured with surgery if found early. Unfortunately, most people do not develop symptoms until the cancer has spread.

Tests that can find lung cancer before patients have symptoms include chest x-rays and low-dose computed tomography (computerized x-rays, also called CT scans or LDCT). Screening for lung cancer might involve using one of these tests to lookfor lung cancer in people who have no lung cancer symptoms.

In 2004, the USPSTF did not find sufficient information to recommend for or against screening for lung cancer. The USPSTF has now updated its recommendations to reflect new information.

How did the USPSTF develop these recommendations?

The USPSTF reviewed research published through May 2013 about the benefits and harms of screening for lung cancer. It also commissioned a study that used computer models to estimate the best ages to start and stop screening.

What did the authors find?

The USPSTF found 4 randomized trials that studied LDCT and chest x-ray for lung cancer screening. The largest and best trial showed fewer lung cancer deaths and deaths from any cause in adults with at least 30 pack-years of smoking who had yearly LDCT than in those who had yearly chest x-rays. The other 3 trials were too small to reach definite conclusions.

Harms of screening include radiation exposure, overdiagnosis, and a high rate of false-positive results. “Overdiagnosis” is finding and treating cases of cancer that may never have caused a problem for the patient. “False-positive” means that the test suggests that a patient has lung cancer when he or she does not. False-positive resultscan lead to unnecessary worry, additional tests, and even surgery.

What does the USPSTF recommend that patients and doctors do?

The USPSTF recommends yearly screening with LDCT in adults aged 55 to 80 years who have at least a 30 pack-year history of smoking and who continue to smoke or who have quit less than 15 years ago. Screening should stop once the patient has not smoked for 15 years or develops a health problemthat substantially limits life expectancy or the ability or willingness to have lung surgery if cancer is found.

What are the cautions related to these recommendations?

More research is needed to identify people who are at the highest risk for lung cancer. Focusing screening on these people could decrease false-positive results.





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