In a long-anticipated follow-up to several studies over the past few years and preliminary recommendations issued last summer (as we discussed then), the quasi-official Federal health panel, United States Preventive Services Task Force (USPSTF) issued its official lung cancer screening guidelines/recommendations. These were published in the Annals of Internal Medicine yesterday, along with two editorial commentaries.
To summarize, the panel urges physicians to get their high-risk smokers (and certain former smokers) an annual screening chest CT scan. The eligibles include over-55 years of age smokers with at least a 30-pack-year history one pack of cigarettes per day for 30 years, 2 packs per day for 15 years, etc. Those ex-smokers with an eligible pack-year history, who quit less than 15 years before, should also be screened. Also, in order to benefit from screening to have the chance to have one s life saved by finding and removing a potentially lethal lesion the patient would have to be in good enough general shape to withstand further testing, including biopsy if indicated, and tolerate surgery if a dangerous lesion is found (in other words, people with late-stage heart, kidney or lung disease or other cancers would not be eligible).
Lung cancer is the number 1 cancer killer in the U.S. and the western world. Almost 90 percent of cases totalling about 160,000 in our country are caused by smoking. While the new USPSTF recommendation which if implemented ideally might save over 20,000 Americans from lung cancer death is quite important, "It's very clear that the best way to prevent lung cancer deaths is to quit smoking," task force co-vice chair Micheal L. LeFevre, MD, MSPH, of the University of Missouri in Columbia, told MedPage Today. "So we have that emphasized much more significantly, particularly in the section called clinical considerations, to make sure people don't think this is an excuse to keep smoking."
ACSH s Dr. Gilbert Ross had this to add: I would say, quit, but better still, don t even start. Also, while the official statement has an upper age limit for screening of 79, I would quibble with that: in my practice last century, I had many older patients who were quite vibrant and active, and I would certainly get an 85 year old in excellent overall health screened if otherwise eligible. But that s the art of medicine, wherein clinical judgment can supersede official guidelines. As for quitting, it s too bad so many smokers want to quit, and over half try each year but cannot. Hopefully, the official antipathy against electronic cigarettes will ebb and disappear as the salutary data start rolling in, as soon as 2014.
If you re not sure about whether to get a CT scan, check out this risk tool, constructed by a specialist at Memorial Sloan-Kettering Cancer Center in NYC. And of course, discuss this with your own doctor!
