American Cancer Society Lung Cancer Screening Guidelines

Chair and Alumni Professor, Department of Family and Community Medicine, Thomas Jefferson University Medical College, Philadelphia, PA.
CA A Cancer Journal for Clinicians (Impact Factor: 115.84). 01/2013; 63(2). DOI: 10.3322/caac.21172
Source: PubMed


Answer questions and earn CME/CNE Findings from the National Cancer Institute's National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation. CA Cancer J Clin 2013;. © 2013 American Cancer Society.

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    • "On 4th July 2011, the International Association for the Study of Lung Cancer (IASLC) published the statement on CT screening for lung cancer in 7 different languages. The National Comprehensive Cancer Network (NCCN) guideline was published in 2012 and further recommendations followed by the American Lung Association22 and the American College of Chest Physicians/American Society of Clinical Oncology23, the American Association for Thoracic Surgery24 and the American Cancer Society25 and the US preventive societies task force26. Table 2 summarizes the recommendations. "
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    ABSTRACT: The US National Lung Screening Trial (NLST) demonstrated a 20% reduction in lung cancer mortality and a 6.7% decrease in all-cause mortality. The NLST is the only trial showing positive results in a high-risk population, such as in patients with old age and heavy ever smokers. Lung cancer screening using a low-dose chest computed tomography might be beneficial for the high-risk group. However, there may also be potential adverse outcomes in terms of over diagnosis, bias and cost-effectiveness. Until now, lung cancer screening remains controversial. In this review, we wish to discuss the evolution of lung cancer screening and summarize existing evidences and recommendations.
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    • "The agreement and reliability of the fully automated scoring are good when compared to reference scores. Lung cancer screening for which guidelines have been published [27] enables additional identification of subjects at risk of CVD. Given the large number of potential participants automated quantification may prove of great value. "
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    ABSTRACT: To determine the agreement and reliability of fully automated coronary artery calcium (CAC) scoring in a lung cancer screening population. 1793 low-dose chest CT scans were analyzed (non-contrast-enhanced, non-gated). To establish the reference standard for CAC, first automated calcium scoring was performed using a preliminary version of a method employing coronary calcium atlas and machine learning approach. Thereafter, each scan was inspected by one of four trained raters. When needed, the raters corrected initially automaticity-identified results. In addition, an independent observer subsequently inspected manually corrected results and discarded scans with gross segmentation errors. Subsequently, fully automatic coronary calcium scoring was performed. Agatston score, CAC volume and number of calcifications were computed. Agreement was determined by calculating proportion of agreement and examining Bland-Altman plots. Reliability was determined by calculating linearly weighted kappa (κ) for Agatston strata and intraclass correlation coefficient (ICC) for continuous values. 44 (2.5%) scans were excluded due to metal artifacts or gross segmentation errors. In the remaining 1749 scans, median Agatston score was 39.6 (P25-P75∶0-345.9), median volume score was 60.4 mm3 (P25-P75∶0-361.4) and median number of calcifications was 2 (P25-P75∶0-4) for the automated scores. The κ demonstrated very good reliability (0.85) for Agatston risk categories between the automated and reference scores. The Bland-Altman plots showed underestimation of calcium score values by automated quantification. Median difference was 2.5 (p25-p75∶0.0-53.2) for Agatston score, 7.6 (p25-p75∶0.0-94.4) for CAC volume and 1 (p25-p75∶0-5) for number of calcifications. The ICC was very good for Agatston score (0.90), very good for calcium volume (0.88) and good for number of calcifications (0.64). Fully automated coronary calcium scoring in a lung cancer screening setting is feasible with acceptable reliability and agreement despite an underestimation of the amount of calcium when compared to reference scores.
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    • "Plusieurs sociétés savantes ont conduit une réflexion identique à la nôtre, avec des propositions similaires. En particulier , l'American College of Chest Physicians, l'American Society of Clinical Oncology et l'American Cancer Society reprennent les critères d'éligibilité de l'essai NLST [11] [14]. Sur la base de données épidémiologiques , le National Comprehensive Cancer Network et l' American Association for Thoracic Surgery ont proposé d' élargir le dépistage aux sujets âgés de 50 ans ou plus , ayant fumé plus de 20 paquets - années et ayant un facteur de risque de cancer supplémentaire , comme une exposition au radon , des anté - cédents personnels de cancer lié au tabac , des antécédents familiaux de cancer broncho - pulmonaire , ou ayant une pathologie pulmonaire chronique ( broncho - pneumopathie chronique obstructive ou fibrose pulmonaire ) [ 12 , son utilisation limite considérablement le nombre de faux positifs . "

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