Annals of Internal Medicine tip sheet for July 30, 2013

Screening Asymptomatic High-Risk Adults for Lung Cancer May Reduce Deaths

A systematic review of the evidence suggests that screening asymptomatic high-risk adults at risk for lung cancer using low-dose computed tomography (LDCT) may reduce mortality. Lung cancer is the third most common cancer in the United States and is the leading cause of cancer-related death for both men and women. Smoking is the most significant risk factor for lung cancer, accounting for approximately 85 percent of lung cancer cases. The risk continues even after smoking cessation, so current and former smokers are considered at risk. Being diagnosed at an early stage of disease is associated with lower lung cancer mortality. However, 75 percent of patients are diagnosed only after symptoms occur from later stage disease. Researchers for the United States Preventive Services Task Force (USPSTF) reviewed 67 articles published since 2000 to assess the benefits and harms of screening asymptomatic high-risk adults for lung cancer using LDCT. This systematic evidence review was conducted to update to the Task Force's 2004 recommendation statement. Previously, the USPSTF found insufficient evidence to recommend for or against screening asymptomatic persons for lung cancer using chest x-ray or LDCT. This current review showed a benefit for LDCT screening at reducing lung cancer and all-cause mortality. There were some harms associated with LDCT screening, such as radiation exposure, over-diagnosis, and incidental findings, but the researchers concluded that the benefit of early detection outweigh the potential harms in certain high-risk populations. A draft recommendation will be posted for public comment to http://www.uspreventiveservicestaskforce.org on July 29 at 5:00 p.m.