September 2007 Press Release
NEW LUNG CANCER GUIDELINES OPPOSE GENERAL CT SCREENING
Lung Cancer Recommendations - Avoid Select Vitamins, Try Acupuncture
(NORTHBROOK, IL, September 10, 2007) —New evidenced-based guidelines from the
American College of Chest Physicians (ACCP) recommend against the use of low-dose computed tomography
(LDCT) for the general screening of lung cancer. Published as a supplement to the September issue of CHEST,
the peer-reviewed journal of the ACCP, the guidelines cite there is little evidence to show lung cancer screening
impacts mortality in patients, including those who are considered at high risk for the disease. The guidelines
also recommend against the use of vitamin or mineral supplements for the prevention of lung cancer, for these
do little to decrease the risk of lung cancer, while beta-carotene has been associated with increased risk of lung
cancer.
“Even in high risk populations, currently available research data do not show that lung cancer screening
alters mortality outcomes,” said W. Michael Alberts, MD, FCCP, chair of the ACCP lung cancer guidelines and
Chief Medical Officer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. “We hope that one
day, we can find a useful and accurate tool for general lung cancer screening, but, at this time, the evidence does
not support the use of LDCT screening.”
In its second edition, Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Clinical
Practice Guidelines (2nd Edition) provides 260 of the most comprehensive recommendations related to lung
cancer prevention, screening, diagnosis, staging, and medical and surgical treatments. The guidelines also
review complementary and integrative therapy for the prevention and treatment of lung cancer.
SCREENING
Due to the lack of supporting evidence, the guidelines recommend against the use of LDCT, chest
radiographs, or single or serial sputum cytologic evaluation for lung cancer screening in the general population,
including smokers or others at high risk, except in the context of a well-designed clinical trial.
“Population screening for lung cancer is not recommended and may, ultimately, put the patient at risk
for further complications,” said Gene L. Colice, MD, FCCP, vice chair of the ACCP lung cancer guidelines and
Director, Pulmonary, Critical Care, and Respiratory Services, Washington Hospital Center, Washington, DC.
“Nodules are commonly found during screening; however, to determine whether they are cancerous requires
additional testing, which is fairly invasive and extensive. This may cause the patient needless risk, both
physically and psychologically.”
PREVENTION
The guidelines also recommend against the preventive use of several of the following common
supplements and medications in at-risk patients or those with a history of lung cancer:
Beta-carotene – The guidelines strongly recommend against the use of beta-carotene supplements for
primary, secondary, or tertiary prevention, citing the higher incidence of lung cancer among those who use the
supplement.
Vitamin A – The guidelines strongly recommend against the use of retinoids (vitamin A), including
isotretinoin, for they have not been shown to decrease the incidence of second tumors and could increase
mortality among current smokers.
Vitamin E – Vitamin E is not recommended for lung cancer prevention, as studies show no difference
in the incidence of lung cancer among those taking vitamin E compared with those not taking it.
Aspirin – Although some literature suggests that aspirin may play a protective role regarding cancer, the
guidelines do not recommend aspirin for the prevention of lung cancer, as studies show that aspirin does not
decrease the risk of lung cancer or death due to lung cancer.
INTEGRATIVE THERAPY
For the first time, the ACCP lung cancer guidelines have included recommendations on mind-body
modalities as part of a multimodality approach to reduce the anxiety, mood disturbances, and chronic pain
associated with lung cancer. Massage therapy is recommended for patients who are experiencing anxiety or
pain, while acupuncture is recommended for patients experiencing fatigue, dyspnea, chemo-induced
neuropathy, or in cases where pain or nausea/vomiting is poorly controlled. Electrostimulation wristbands are
not recommended for managing chemo-induced nausea/vomiting, as studies show that they do little to delay
nausea/vomiting compared with placebo.
The recommendations were rigorously developed and reviewed by 100 multidisciplinary panel
members, including pulmonologists, medical oncologists, radiation oncologists, thoracic surgeons, integrative
medicine specialists, oncology nurses, pathologists, health-care researchers, and epidemiologists. The
guidelines were further reviewed and approved by the ACCP Thoracic Oncology NetWork, the Health and
Science Policy Committee, the Board of Regents, and external reviewers from the journal CHEST. The
guidelines have been endorsed by the American Association for Bronchology, American Association for
Thoracic Surgery, American College of Surgeons Oncology Group, American Society for Therapeutic
Radiology and Oncology, Asian Pacific Society of Respirology, Oncology Nursing Society, Society of Thoracic
Surgeons, and the World Association of Bronchology.
Lung cancer continues to be the leading cause of cancer deaths in men and women in the United States,
causing more deaths than the next four most common cancers combined, including colon, breast, pancreas, and
prostate. Thirty-one percent of cancer deaths in men are attributable to lung cancer, while the number is slightly
lower at 26% in women. However, if current trends continue, the incidence of lung cancer will be identical for
men and women during the next decade.
“Each year, great strides are made in the diagnosis and treatment of lung cancer, allowing patients with
the disease to live longer and increase the quality of their lives. However, the real culprit behind lung cancer is
tobacco,” said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. “Avoiding
tobacco is the key to preventing most forms of lung cancer. Until we eliminate tobacco use completely, we will
continue to deal with its devastating health consequences.”
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at
www.chestjournal.org. The ACCP represents 16,600 members who provide clinical respiratory care, sleep
medicine, critical care, and cardiothoracic patient care in the United States and throughout the world. The
ACCP’s mission is to promote the prevention and treatment of diseases of the chest through leadership,
education, research, and communication. For more information about the ACCP, please visit the ACCP Web
site at www.chestnet.org.
Contact:
Jennifer Stawarz, (847) 498-8306
Deana Busche, (847) 498-8387
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