CT Lung Cancer Screening Guidelines May Miss Some At Risk

MedicalResearch.com Interview with:
David Mithun, M.D.

Division of Pulmonary and Critical Care Medicine
Mayo Clinic, Rochester, Minnesota

Medical Research: What is the background for this study?

Dr. Mithun: Lung cancer screening should be pursued for those people at highest risk who are otherwise in good enough health to be able to undergo curative intent treatment if cancer is found. The current criteria for screening recommended by the US Preventive Services Task Force of age 55-80 years, 30 pack-years of smoking, and if quit, have done so within 15 years and are based on the National Lung Screening Study (NLST).

Medical Research: What are the main findings?

Dr. Mithun: Our data was retrospective over a 28 year time period and showed that an increasing number of people who actually got cancer would not have been candidates for screening based on the current criteria.  This suggests there may be some degree of mismatch between risk as defined by the current criteria to screen and those who developed cancer.  An increasing number of those who would not have been candidates for screening yet got lung cancer were among those who quit smoking 15 years or longer.

Medical Research: What should clinicians and patients take away from your report?

Dr. Mithun: We do not feel that these findings should change practice or liberalize screening recommendations.  The data highlight the need for further study to identify those at highest risk for lung cancer who may benefit from screening beyond age and pack-years and a quit time of 15 years.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Mithun: Using only age, pack-year history and quit time is a relatively blunt instrument to determine risk for lung cancer.  We know of several additional factors such as personal history of lung cancer, family history of lung cancer and presence of chronic obstructive pulmonary disease that indicate elevated risk.  As well the risk of lung cancer falls with smoking cessation compared to continued smoking, but remains elevated over that of a never smoker, and risk increases with age. In deciding who to screen for lung cancer, a more sensitive tool is needed to determine risk while balancing the potential harms from screening

Citation:

Wang Y, Midthun DE, Wampfler JA, et al. Trends in the Proportion of Patients With Lung Cancer Meeting Screening Criteria. JAMA. 2015;313(8):853-855. doi:10.1001/jama.2015.413.

 

MedicalResearch.com Interview with: David Mithun, M.D. (2015). CT Lung Cancer Screening Guidelines May Miss Some At Risk