The United States Preventative Services Task Force recommendation (most recently updated in 2004) is that the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with LD-CT, CXR, sputum cytology, or a combination of these tests. The USPSTF recommendation has not been revised based on the NLST study. However, the task force is compiling evidence, and a draft of its most current recommendations will be available for public review in 2013.
All decisions regarding lung cancer screening must include an open discussion between physicians and their patients regarding the potential benefits and harms of screening, including false-positive results, the psychological effects of those results, and potential complications related to further diagnostic evaluation. The financial burden to the patient must also be included in this discussion, as initial screening is rarely an insurance-covered benefit.
References
• Wender, R., et al. American Cancer Society lung cancer screening guidelines (CA Cancer J. Clin. 2013;63:106-17).
• Klabude, C., et al. Lung cancer screening practice of primary care physicians: results from a national survey (Ann. Fam. Med. 2012;10:102-10).
• Humphrey, L.L., Teutsch, S., Johnson, M.S. Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography: an update from the U.S. Preventive Services Task Force (Ann. Intern. Med. 2004;140:740-53).
• Bize, R., Burnand, B., Mueller, Y., Rège-Walther, M., Camain, J.Y., Cornuz, J. Biomedical risk assessment as an aid for smoking cessation (Cochrane Database Syst. Rev. 2012;12:CD004705).
• Ferketich, A.K., Otterson, G.A., King, M., Hall, N., Browning, K.K., Wewers, M.E. A pilot test of a combined tobacco dependence treatment and lung cancer screening program (Lung Cancer 2012;76:211-5).
• van der Aalst, C.M., de Koning, H.J., van den Bergh, K.A., Willemsen, M.C., van Klaveren, R.J. The effectiveness of computer-tailored smoking cessation intervention for participants in lung cancer screening: a randomized control trial (Lung Cancer 2012;76:204-10).
Dr. Vancil is an assistant professor of internal medicine at the University of Arkansas, Little Rock. Dr. Golden is medical director of Arkansas Medicaid and professor of medicine and public health at the University of Arkansas. Dr. Hopkins is director of the division of general internal medicine at the University of Arkansas. E-mail them at imnews@frontlinemedcom.com. They reported having no relevant financial conflicts.