Population screening for lung cancer discouraged

The new guidelines for the initial diagnosis of lung cancer issued by the American College of Chest Physicians discourage population screening for lung cancer, even though lung cancer remains the leading cause of cancer death in men and women in the United States. While death from other types of cancer continues to decline, deaths from lung cancer continue to rise.

But the evidence shows that screening is not the answer, at least not at this point. Lung cancer screening with chest radiography and sputum cytology has failed to lower lung cancer mortality rates, even in high-risk populations.

Population screening for lung cancer is not recommended and may ultimately put the patient at risk for further complications, coinvestigator said. Nodules are commonly found during screening: however, to determine whether they are cancerous requires additional testing, which is fairly invasive and extensive. This may cause the patient needless risk, both physically and psychologically.

Sputum cytology is effective for establishing the diagnosis of lung cancer and is particularly useful in patients with a centrally located tumor or in those with hemoptysis.

Endobronchial ultrasound has recently shown potential in increasing the diagnostic yield of flexible bronchoscopy (FB), the guidelines authors note. In experts hands, a radial probe ultrasound device can increase the diagnostic yield of FB while dealing with peripheral lesions of <29 mm in size.

When screening a patient for lung cancer, the guidelines recommend avoiding the use of:

• Low-dose helical computed tomography, except in clinical trials

• Serial chest radiographs

• Single or serial sputum cytologic evolution.

In patients with suspected small-cell lung cancer or with clear evidence of advanced non-small-cell lung cancer, the easiest diagnostic modality should be used. Reliable techniques for differentiating between small-cell and non-small-cell lung cancer are:

• Sputum cytology

• Transthoracic-needle aspiration cytology

• Bronchoscopic washings, brushings, and bronchoalveolar lavage cytology.

Chemoprevention

For people with a >20 pack-year history of smoking or those with a history of lung cancer, the following agents are not recommended for chemoprevention of lung cancer.

• Beta-carotene supplementation

• Vitamin E

• Retinoids

• N-acetylcysteine

• Aspirin