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New Lung Cancer Guidelines Recommend Screening for High-Risk Individuals

Older, heavy smokers should have CT scan (May 7)

New evidence-based lung cancer guidelines from the American College of Chest Physicians (ACCP) recommend offering low-dose computed tomography (LDCT) scanning for lung cancer screening to people with a significant risk of lung cancer due to age and smoking history.

Published as a special supplement to the May issue of the ACCP journal Chest, the guidelines cite evidence to show that lung cancer screening can reduce lung cancer deaths among individuals who are at increased risk of developing the disease. The guidelines also document the advances made during the past 5 years in the treatment of tobacco use, including the benefits of tobacco cessation programs, in patients with lung cancer. According to the guidelines, the most effective deterrent to acquiring lung cancer is the avoidance of tobacco products.

For individuals at increased risk of developing lung cancer, the guidelines recommend offering LDCT scanning to screen for lung cancer in the context of a structured, organized screening program. The recommendation is based on a systematic review of the data, which show an important reduction in deaths from lung cancer when screening is done in an organized program. This is a change from the prior edition of the guidelines, released in 2007, when such evidence was not available, the ACCP says.

Treatment procedures detailed in the guidelines include the benefits of minimally invasive surgery whenever possible, as well as the benefit of treatment at specialized centers. Today, patients with limited lung function also have treatment options, such as stereotactic body radiosurgery, which is similar to using a global positioning system (GPS) to deliver a laser-accurate strike to a tumor. Molecular-based targeted chemotherapy can also shut down the cellular engine that drives a tumor’s growth. The guidelines also make it clear that a sophisticated approach to symptom control and palliative care can markedly improve both the quality and quantity of life for patients with lung cancer.

For those with advanced disease, a major concern is palliation. In the past, the approach to palliative care was largely empiric, but as summarized in the guidelines, a large body of research has led to the development of a more formal evidence-based process. Many tools are available for managing cancer symptoms as well as for facilitating the process of end-of-life care. The data also demonstrate that early inclusion of a palliative-care team in the management of advanced lung cancer has meaningful quality-of-life benefits for these patients.

Sources: ACCP; May 7, 2013; and Chest; May 2013.

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