ALA recommends low-dose CT screening for current, former smokers with at least 30 pack-years, ages 55 to 74

Low-dose screening with computed tomography (CT) should be recommended for people who meet National Lung Screening Trial (NLST) criteria: current or former smokers age 55 to 74 years with a smoking history of at least 30 pack-years and no history of lung cancer, according to a guidance statement released last week by the American Lung Association (ALA).

People should not receive a chest X-ray for lung cancer screening, and low-dose CT screening is not recommended for everyone, according to an interim report published on the ALA's website. Although the U.S. Preventive Services Task Force has not recommended screening for lung cancer, results from the National Cancer Institute's NLST, published in the New England Journal of Medicine in August 2011, showed that screening high-risk individuals with CT scans reduced lung cancer deaths by 20.3% compared to chest X-rays, the ALA report noted. The number needed to treat was 320.

Based on the results of that trial, the committee made several specific recommendations, including the following:

• Low-dose CT screening should be recommended for those who meet the NLST criteria.
• Smoking cessation or never smoking is the best way to prevent smoking-related lung cancer.
• Universal screening is not recommended because of the questions that remain about optimal methods and effectiveness in general populations, as in well as high-risk populations such as patients with chronic obstructive pulmonary disease.
• Patient education is important, not only to encourage smoking cessation but also to teach patients about the risks of radiation exposure, about how to follow up on abnormal findings, and that a negative result does not rule out future lung cancer.
• The ALA should develop a toolkit that outlines patient information in coordination with discussions with a pulmonologist or other physician.
• Hospitals and screening centers should establish ethical policies for advertising and promoting lung cancer screening, especially because Medicare and private insurers don't cover the costs, as well as avoid using direct-to-consumer advertising or promotions that prey upon public fears about lung cancer.
• Screening should be linked to “best practice” multidisciplinary teams that can provide follow-up evaluation of nodules.