The American College of Chest Physicians recommends screening with low-
dose computed tomography — but only in a carefully defined population.
The American College of Chest Physicians has published a new clinical
guideline on screening for lung cancer. The key recommendation is:
“For smokers and former smokers who are age 55 to 74 and who have
smoked for 30 pack-years or more and either continue to smoke or have
quit within the past 15 years, we suggest that annual screening with
LDCT [low-dose computed tomography] should be offered . . . but only
in settings that can deliver the comprehensive care provided to NLST
[National Lung Screening Trial] participants.”
This cautious language reflects several points that the guideline
addresses in detail. First, because the NLST is the only randomized
trial that has shown a mortality benefit (JW Gen Med Jul 14 2011), the
authors believe that screening should be limited to people whose age
and smoking histories meet the NLST eligibility criteria.
Second, the authors acknowledge the problem of false positives —
i.e., CT scans can identify abnormalities that generate additional
tests and procedures in people who don’t have lung cancer (JW Gen Med
May 22 2013). Further evaluation of patients with false-positive scans
is costly, potentially anxiety-provoking, and potentially harmful if
invasive tests are performed.
Third, the authors are concerned about screening that is done
haphazardly in community practice settings. Many patients with benign
nodules can be followed without undergoing biopsies, and very few
patients with benign nodules should need surgery to establish
benignity. When diagnostic surgery is required, video-assisted
thoracic surgery is preferable. The authors believe that screening
should be done only in centers where expert multidisciplinary
management and follow-up are available.