Lung cancer: US experts publish new screening guidelines

The New guidelines from medical experts will almost double the number of people in the United States who are recommended for CT scans annual lung cancer screening and will include many more African Americans and women than in the past.

The disease is the leading cause of cancer death in the United States Yes the goal of expanded screening is to detect it early enough to cure it in more people at high risk of smoking. In these people, annual CT scans can reduce the risk of death from cancer by 20 to 25%, according to large studies.

The new recommendations, from the United States Preventive Services Task Force, include people aged 50 to 80 who have smoked at least one pack a day for 20 years or more, and who still smoke or have quit in the past 15 years.

The opinion, published Tuesday in the medical journal JAMA, differs in two respects from previous working group guidelines, issued in 2013: reduces the age at which screening tests should start, from 55 to 50 years, and reduces the history of smoking to 20 years, from 30 years.

These changes will add more women and African Americans in the group eligible for screening, because they tend to smoke less than the white males in the study on which the guidelines above are based. Women and African Americans also tend to develop lung cancer earlier and have less exposure to tobacco than white men. the experts said. However, it is not known why the risk appears to differ by race and gender.

“Some studies have hinted at certain hormonal influences in women,” he said in an interview with The New York Times the doctor Mara Antonoff, pulmonary surgeon Anderson Cancer Center in Houston. “In terms of racial differences, we don’t have an answer. We have population-based data to show that they tend to develop lung cancer at a younger age and with less exposure to tobacco, but we don’t have a mechanism. “

According to the new criteria, 14.5 million people in the United States will be eligible for the exam, an increase of 6.4 million. The working group includes 16 doctors, scientists and public health experts They regularly assess screening tests and preventive treatments. Members are appointed by the director of the Agency for Research and Quality of Health Care (AHRQ), but the group is independent and its recommendations often help shape medical practice in the United States.

The use of chest x-rays to screen for lung cancer were largely abandoned decades ago because they could not detect the disease early enough to be of use. The CT scan, called low dose CT scans because they involve a relatively small amount of radiation, they cost around $ 300. Patients are advised to stop screening once they have not smoked for 15 years, or if they develop health problems that would significantly shorten their life expectancy or prevent them from having lung surgery if necessary. .

Patients did not flock to clinics for this exam. The researchers believe that only 6 to 18 percent of those who qualify and could be helped by the exam took advantage of it. Some cannot afford it. “Part of the low acceptance is simply lack of access to care ”, assured the doctor Robert Smith, screening expert for American Cancer Society. “Smoking in general is increasingly concentrated in low-income populations.”

The Affordable Care Act of the North American country requires insurers to cover any valuation widely recommended by the task force at no direct cost. But the researchers found that half of the population eligible for lung cancer screening was not insured.

Black-smith and other researchers have also stated that patients may miss lung cancer screens because they just don’t know it. It hasn’t received as much attention as other cancer screenings, such as mammograms, colonoscopies, and Pap tests. Some doctors may not encourage you as much, and especially with ex-smokers, they may not take the time to calculate a patient’s smoking history to see if it meets guidelines.

“The changes in criteria for smoking history Yes age of detection they were based on new data from several studies ”, Highlighted Alex H. Krist, chair of the working group and professor of family medicine and population health Commonwealth University of Virginia. “Lung cancer it is the leading cause of cancer death in the United States ”, He said Christ, and added that With the new data, “we are even more convinced that screening tests save lives.”

Like other types of drug tests affected by the pandemic, lung cancer rates remain below 2019 levels, based on an analysis of data from Medicare realized by Avalere Health, a consulting firm, created for Community Oncology Alliance, representing independent cancer specialists.

As the number of screenings started to rebound this summer, the new spike in COVID-19 cases later in the year caused them to drop again. In November, screening tests were reduced by 30%, compared to 2019, and the number of lung biopsies has also decreased, indicating that no case was diagnosed.

Using your own scoring system, the working group gave its recommendation a B, saying there was “moderate certainty” that the annual valuation was “moderate net benefit”. This may not seem like a resounding endorsement, as an A rating means “high certainty that the net benefit is substantial.” But everything marked A or B must be offered to patients, according to the rules of the working group.

“There is growing evidence that a fairly simple five minute scan at low dose and low radiation can actually save the lives of many people. “ said the doctor Bernard J. Park, pulmonary surgeon and clinical director of the pulmonary examination service of Memorial of Centro Oncológico Sloan Kettering from New York. “About 75 to 85 percent of the cancers found with this test are stage 1 and can be cured with surgery or radiation therapy alone.” valued.

At the World level, there were 2.09 million new cases of lung cancer in 2018, and the disease too it is the main cause of death from cancer, killing 1.76 million people that year, according to the World Health Organization.

There was 228,820 new cases of lung cancer in the United States in 2020, Y 135,720 people died from it, according to National Cancer Institute. About 90% of cases occur in people who smoke, and the risk of current smokers of developing the disease is about 20 times that of non-smokers.

Solo about 20.5 percent of patients survive five years after diagnosis. Most cases are diagnosed late, after the cancer has started to spread. But if it can be found and treated in time, a cure is possible, say the doctors.

The CT screening tests carry risks, and the doctors say that they should be explained to patients, who may decide to decline the test. “The scans find small nodules in the lungs that may or may not be early cancers. A suspicious stain could just be a minor infection, inflammation or mild growth, ”he said. to park.

Often nodules can be monitored with repeated scans, but it can be stressful for patients to spend months waiting for the next test, knowing that there is something in your lungs that might be bad.

The rates of false positives, when something harmless is mistaken for cancer, ranged from 3.9% to 25% and more across studies, but they tend to decrease over time as the patient has more annual scans. One of the main concerns with false positives is that they can lead to invasive procedures like lung biopsies. A large study found that invasive procedures were performed unnecessarily in 1.7 percent of patients assessed. The task force report said that the standards created by radiology societies to evaluate scans might help to avoid some unnecessary procedures caused by false positives.

Another possible risk of screening tests is the possibility that cumulative radiation exposure could cause cancer. But the dose is low and the risk is considered low, especially when compared to the risk of lung cancer caused by smoking. In theory, screening could also lead to invasive testing and unnecessary treatment for cancer that has not progressed or harmed the patient. How often this could occur is unknown, but it is considered rare.

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