Panel Advises Annual Lung Cancer Screening for Current and Former Smokers

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For the first time, there’s evidence that screening smokers may save them dying of lung cancer.

The U.S. Preventive Services Task Force (USPSTF) , a government-based panel of experts, released a draft recommendation that smokers between the ages of 55 to 80 who have a history of smoking a pack a day for 30 years or more, as well as those who have quit within the last 15 years, should get low dose CT scans of their lungs to look for possible tumors. Smoking accounts for about 85% of lung cancer, which is among the leading causes of cancer deaths in the U.S. each year.

The advice comes after the USPSTF determined in two previous reviews that there was not enough evidence to support the annual screenings. But new studies support the fact that the small risk of radiation exposure from the low dose scans was outweighed by the benefits of detecting abnormal growths early and intervening with treatments. The National Lung Screening Trial (NLST) study by the American College of Radiology Imaging Network (ACRIN), for example, found that low-dose CT scans reduced lung cancer deaths among former smokers as well as current smokers aged 55 to 74 by 20% compared to X-rays. Another study, published in the journal Cancer found that such CT screening could prevent up to 12,000 lung cancer deaths each year, which could also significantly lower health costs associated with the disease.

(MORE: A New Way to Detect Lung Cancer? Dogs Can Sniff It Out)

When the NLST results were released in 2011, the American College of Radiology issued a statement pledging to create better guidelines, standards, and staffing changes to support more widespread screening. “Evidence-based infrastructure will have to be put in place nationwide to ensure that patients have access to uniform, quality care and a similar life-saving benefit from these exams as demonstrated in the NLST,” the college wrote.

In recent years, the USPSTF has been issuing controversial advice concerning cancer screening, based on updated evaluations of the data. In 2009, the task force recommended that most women delay mammogram screening for breast cancer until age 50, a full decade later than previous guidelines. And last year, the panel found that widespread screening with the prostate specific antigen (PSA) test was not contributing to fewer deaths from prostate cancer, and advised men to skip the test altogether.

With the current lung cancer recommendation, the Task Force joins organizations such as the American College of Chest Physicians, American Society of Clinical Oncology, the American Thoracic Society, the National Comprehensive Cancer Network (NCCN) and the American Lung Association, which have been recommending lung cancer screening with low dose CT scans for those at-risk since May 2012.

(MORE: No More Chemo: Doctors Say It’s Not So Far-Fetched)

The proposed recommendation is available for public comment until August 26, after which the task force will make any suggested modifications and issue its final guidelines. At that point, insurance companies will have to reimburse annual lung cancer screenings for the appropriate populations, as designated under the the Affordable Care Act.

But with more screening, some experts say there will be confusion over the CT’s false positive and false negative readings. The test misses about 20% of lung cancers, and can falsely detect tumors at high rates as well, which means more people may be diagnosed with cancer who might not have malignant growths. “Overdiagnosis is guaranteed,” Dr. Peter Bach, the director of Memorial Sloan-Kettering Cancer Center’s Center for Health Policy and Outcomes told Reuters about the new recommendation.

Task Force member Dr. Michael LeFevre of the University of Missouri in Columbia says overdiagnosis is inevitable in screening in general, and in cancer screening specifically. The panel estimates that around 3% to  4% of the cancers that are detected through screening may never have caused a person a problem in their lifetime. “By contrast, from a Task Force perspective, back when we made our last recommendation about mammography, we were looking at a 10% overdiagnosis estimate,” he says. “We consider 3% to 4% pretty low considering the devastating consequences of lung cancer in the United States today.”

Screening, however, cannot substitute for the protective effect of quitting smoking, says the task force, and the panel stresses that the most effective way to lower deaths from lung cancer is to reduce smoking rates.

9 comments
AsadAliKhatri1
AsadAliKhatri1

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v.shapoval.molbio
v.shapoval.molbio

Screening smokers may save them dying of lung cancer? Why do some individuals smoke and others do not? Why can some smokers quit, while others cannot? Why do certain smokers develop lung cancer, while others, despite prolonged use of cigarettes, do not? Lung cancer is the deadliest type of cancer for both men and women. Each year, more people die of lung cancer than of breast, colon, and prostate cancers combined. Similar to many other cancers, lung cancer is initiated by accumulation of superparamagnetic, ferrimagnetic and ferromagnetic nanoparticles in pre-cancerous cells. These nanoparticles chaotically distort DNA and shift chromosomes by local magnetic fields. Genetic predisposition to abnormal iron metabolism (i. m. is the sum of the chemical and physical processes whereby iron is introduced into or evacuated from the body) and genetic predisposition to infectious and non-infectious lung diseases mean genetic predisposition to lung cancer. If, in some individuals, a heritable basis exists for nicotine and alcohol dependence, one gene or a few genes may be shared in these disorders. Smoking, infectious and non-infectious diseases affect iron metabolism. Inhaled asbestos fibers contain iron ions and iron nanoparticles. Non-iron diet (natural dairy products are low in iron; apples and blueberries contain very little iron), anti-iron menstrual bleeding or/and anti-iron bleeding disorders (intestinal bleeding, bleeding gums, unexplained nosebleeds) can save some smokers, asbestos workers and iron-ore (hematite) miners. Lung cancer should be interpreted as intracellular superpara-ferri-ferromagnetic infection. According to the Ferromagnetic Cancer Theory (Theory from The OLD TESTAMENT; Iron Conception), accurate anti-iron methods of The Old Testament can successfully beat lung cancer. Anti-iron intratumoral injections [sulfur (2%) + olive oil (98%); 36.6C - 39.0C] or/and [water containing hydrogen sulfide] (by ceramic needles) can suppress primary and secondary lung tumors and large metastases; can give harmless infiltrations (deposits of cells that die; harmless necroses; benign capsules). Anti-iron slow blood loss (even 75%) [hemoglobin control], anti-iron goat’s milk diet and anti-iron drinking water containing hydrogen sulfide can neutralize any micrometastases and isolated tumor cells.  http://healthland.time.com/2013/07/30/panel-advises-annual-lung-cancer-screening-for-current-and-former-smokers/  ;  http://www.medicalnewstoday.com/opinions/102131/  ;  http://www.scientificamerican.com/article.cfm?id=why-some-smokers-get-lung  ;  Together We (TIME, Medical News Today, SCIENTIFIC AMERICAN and Vadim Shapoval) Will Beat CANCER

RNCounselor
RNCounselor

I am so glad that I read your article on CT scans and smoking. My identical twin sister, who still smokes, gets CT scans every two years. This year a lymph node was identified as enlarged. A PET scan identified it as a cancer- no primary was found. She now has to undergo a difficult treatment protocol for several months more with no guarantees about the future.

She nagged me to get a CT scan even though a chest X-ray was negative. I had stopped smoking 17 years ago. The CT scan showed a small tumor in a lung. My tumor is very slow growing and, once removed, will not require chemotherapy or radiation therapy. Had it not been identified in this early stage, the outcome could have been very different.

I am VERY glad that I read your article, Alexandra Sifferlin , in Time published two months ago. I believe that it saved my life. I know that the CT scan was instrumental in finding my sister's lung cancer.  Thank you!

As a RN and patient advocate, I now tell my story to smokers that I know and, once the tumor is removed, I will also tell my patients that they need to request a CT scan from their physicians as a baseline, but also to rule out a lung cancer at its earliest stage.

Yet another Time article that has real importance to their readers.  Well done and thank YOU for saving my life.

]Trudy N. Lechner, RN, BA, CDE

Miami, FL

ruhling7
ruhling7

Are we CRAZY?  X-rays every 3 months would not detect cancer soon enough. Why should I be taxed to pay for high cost scan and treatment of cancer for someone who chooses that outcome by smoking? And where in the Constitution does it say that the government should tax anyone to provide "healthcare"? And it's not healthcare--it's medical care with prescription drugs. (Congress LOVES drug contributions to their re-election campaigns) http://LeadingCauseOfDeathPrescriptionDrugs.com

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FlowerJasmin
FlowerJasmin

My cousin is 47 and long time smoker. He has lung cancer which is spreading now to his brain. Last 6 month has been a nightmare to all of us and nobody told anything to his mom yet. Every smoker has to understand the pain they cause to their loved ones.