September 2007 Press Release
NEW LUNG CANCER GUIDELINES OPPOSE GENERAL CT SCREENING
New Recommendations for Lung Cancer Diagnosis/Treatment in Nonsmokers
(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.
“Even in high risk populations, current research does not show that lung cancer screening alters mortality outcomes,” said W. Michael Alberts, MD, FCCP, co-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 include new recommendations related to (BAC), often seen in nonsmokers, and updated recommendations related to adjuvant chemotherapy after surgical resection and the diagnosis and treatment of solitary pulmonary nodules.
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.”
BRONCHIOLOALVEOLAR CARCINOMA
For the first time, the ACCP lung cancer guidelines include recommendations on the diagnosis, prognosis, and treatment of bronchioalveolar carcinoma (BAC), a type of lung cancer often seen in nonsmokers or those with minimal smoking history. Recommendations suggest that although staging, diagnosis, and treatment are the same for BAC as for other histologic subtypes of non-small cell lung cancer (NSCLC), additional treatment options exist that may prove to be equivalent, if not more effective, for patients with BAC, including sublobar resection and the use of epidermal growth factor receptor (EGFR) targeted agents. Furthermore, recommendations note that a diagnosis of BAC should be reserved for those tumors meeting the 1999 World Health Organization revised classification system for lung tumors.
ADJUVANT CHEMOTHERAPY
Previous ACCP recommendations did not support postoperative chemotherapy for either Stage I or Stage II NSCLC. However, the new guidelines now support the use of platinum-based adjuvant chemotherapy for patients with completely resected Stage II NSCLC who have good performance status. The change in the recommendation was prompted by new research showing adjuvant therapy significantly reduced the risk of death in patients with Stage II NSCLC.
SOLITARY PULMONARY NODULES
The guidelines also include recommendations on the management of solitary pulmonary nodules (SPN), rounded opacities commonly noted on chest radiographs or CT scans. The new recommendations outline a specific algorithm for the evaluation and management of SPNs and also stress the value of risk factor assessment, the utility of imaging tests, the need to weigh the risks and benefits of different management strategies, and the importance of obtaining patient preferences.
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 use,” 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 journal’s Web site also provides public access to thousands of archived studies, dating back to 1946—a newly added feature that is free of charge. 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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