LCA calls for public discussion on guidance for lung cancer screening

Today, Lung Cancer Alliance (LCA) President & CEO Laurie Fenton-Ambrose said the recent breakthrough on CT screening for lung cancer is an extraordinary development in the battle against lung cancer and reiterated her call for an open and balanced public discussion on guidance for those at high risk who may be considering a scan.  

"Screening for lung cancer is not a simple one step procedure. It is a process, and a complex one that requires training and experienced professionals using up-to-date, specialized equipment and best management practices," Fenton-Ambrose cautioned.  

LCA reiterated its consistent position that those at risk who are considering a scan should speak with their doctors about the risks and benefits and that scans should only be done at a center experienced in lung cancer screening that has a multi-disciplinary team of doctors who follow best published practices to confirm the diagnosis.  Currently, these sites include:  

• All sites participating in the International Early Lung Cancer Action Program (I-ELCAP) which can be found at: http://www.ielcap.org/members.htm
• Sites recognized by the National Cancer Institute as Cancer Centers or Comprehensive Cancer Centers which can be found at:http://www.cancer.fov/cancertopics/factsheet/NCI/cancer-centers
• NCI Centers hosting Specialized Centers of Excellence

For cancers with screening procedures, such as breast, prostate and colon cancers, standards and guidelines have been developed and adopted to ensure that the screening benefit is provided to stakeholders in a uniform, safe, efficient and effective way.  These guidelines continue to be adapted as new advancements emerge.  Such guidelines have helped to minimize risk, lower costs and improve overall survival.

Fenton-Ambrose continued, "It is extraordinary to now consider evolving similar strategies and benefits for those at high risk for lung cancer.  In the days ahead LCA will be working with leading medical and public health policy experts to develop national standards and guidelines. 

LCA has already called for a formal review of federal recommendations on lung cancer screening in official correspondence to the Agency for Healthcare Research and Quality (AHRQ) responsible for overseeing screening recommendations.  

The National Lung Screening Trial (NLST), launched in 2002, was halted earlier this month by the National Cancer Institute when the evidence became overwhelming that CT screening can dramatically reduce lung cancer deaths in a high risk population.  

The trial recruited 53,500 current or former smokers between the ages of 55 to 74 years of age with a 30 pack year history (number of packs per day x the number of years smoked = total pack years) since that high risk population would have the highest likelihood of being diagnosed with lung cancer.  Half received chest x-rays and the other half CT scans once a year for three years.  

The results were stunning. With only 5 years of follow-up, unusually short for a screening trial, those diagnosed by CT scans had 20% fewer deaths than those diagnosed by chest x-rays.  The overall impact of CT screening on lung cancer mortality compared to no screening at all will be even higher.  By contrast, mammography screening reduces breast cancer mortality by 15%, and PSA testing for prostate cancer much less.

Lung cancer is taking the lives of 160,000 people a year, more than colon, breast, prostate and pancreatic cancers combined.  Since the majority of lung cancer patients have similar ages and smoking history as those in the trial, even the 20% impact translates to tens of thousands of fewer deaths a year, making this the biggest breakthrough ever in reducing overall cancer mortality.