ACCP recommends screening for lung cancer in high-risk patients

The American College of Chest Physicians recommends screening high-risk patients for lung cancer, according to an updated clinical practice guideline released last week.

The guideline, “Diagnosis and Management of Lung Cancer, 3rd edition,” was published as a supplement to the May Chest and was developed through systematic review of all available evidence by an expert panel. The last edition of the guideline, published in 2007, did not recommend screening for lung cancer because the evidence at the time did not support it. New evidence, however, indicates that a structured, organized screening program can reduce lung cancer deaths, the ACCP said in a press release.

The guideline suggests that patients ages 55 to 74 who smoke or have smoked for at least 30 pack-years and either continue to smoke or have quit in the past 15 years be screened annually with low-dose computed tomography. The guideline stresses, however, that such screening should be done “only in settings that can deliver the comprehensive care provided to National Lung Screening Trial participants.”

The guideline does not recommend screening at-risk patients with chest radiography once or at regular intervals, nor does it suggest regular screening with sputum cytology in this group. In addition, the guideline said, computed tomography screening is not suggested in patients with fewer than 30 pack-years of smoking, those younger than age 55 or older than age 74, those who stopped smoking more than 15 years ago, or those with severe comorbid conditions that would preclude attempts at curative treatment or limit life expectancy.

In addition to screening, the guideline covers chemoprevention of lung cancer, treatment of tobacco use, evaluation of pulmonary nodules, initial evaluation of patients with lung cancer, establishing a diagnosis, staging, treatment, among other topics. An executive summary is available online.