USPSTF Recommends Lung Cancer Screening for Those at High Risk for Disease!
Tuesday, July 30, 2013
Posted by: Natalia Gromov
FOR IMMEDIATE RELEASE: July 30, 2013
CONTACT: Peter Hamm, 202-296-5469
Preventive Health Panel Backs Lung Cancer Screening for High-Risk Groups,
Emphasizes Need to Quit Smoking
Statement of Matthew L. Myers
President, Campaign for Tobacco-Free Kids
WASHINGTON, DC –The U.S. Preventive Services Task Force today has taken an important step to help reduce deaths from lung cancer by recommending screening people who are at high risk for the disease with annual low-dose CT scans. To improve early detection of lung cancer, the Task Force recommended screening current and former smokers, age 55-80, with a history of heavy smoking (for example, one pack a day over 30 years or two packs per day over 15 years). This recommendation, which is open for public comment before being finalized, will provide much-needed guidance to physicians regarding who can benefit from lung cancer screening.
Importantly, the Task Force also emphasized the critical need to reduce the number of Americans who smoke and are exposed to secondhand smoke. Smoking is by far the biggest risk fact for lung cancer and accounts for about 85 percent of lung cancers in the United States. As Dr. Michael LeFevre, co-vice chair of the Task Force said, "It’s important to remember that helping smokers stop smoking and protecting non-smokers from exposure to tobacco smoke are the most effective ways to decrease the sickness and death associated with lung cancer. In addition, people who quit smoking willcontinueto see their risk go down over time. Screening for lung cancer is beneficial, but it is not an alternative to quitting smoking.”
To prevent lung cancer and other tobacco-related diseases, elected officials should support proven strategies to prevent kids from smoking, help smokers quit and reduce exposure to secondhand smoke. These include higher tobacco taxes, comprehensive smoke-free laws, well-funded tobacco prevention and cessation programs that include mass-media campaigns,health insurancecoverage for therapies to help smokers quit, and effective regulation of tobacco products and marketing.
Tobacco use is the number one cause of preventable death in the United States, killing about 443,000 people and costing the nation $96 billion in health care bills each year.
U.S. Preventive Services Task Force Press Release
U.S. Preventive Services Task Force Draft Recommendation Statement
Task Force Urges Scans for Smokers at High Risk
Published: July 29, 2013
WASHINGTON — An influential government health panel recommended on Monday that heavy smokers get an annual CT scan to check for lung cancer, a major change in policy that experts said had the potential to save 20,000 lives a year.
Until recently, the medical consensus has been that there is too little evidence to justify lung cancer screening, largely because a chest X-ray — the usual screening technique — seldom catches the cancer early enough for lifesaving surgery.
But that changed in 2010, when a large-scale clinical trial involving 53,000 patients that was conducted by the National Cancer Institute found that a CT scan, which detects much smaller tumors, could reduce mortality by 16 percent among patients at the highest risk of lung cancer. The findings provide the principal basis for the federal panel’s recommendation on Monday.
Lung cancer claims about 160,000 lives a year — more than a quarter of all cancer deaths and greater than the toll from colorectal, breast, pancreatic and prostate cancers combined. Nearly 90 percent of patients with lung cancer die from it, in part because it is discovered too late.
The recommendation by the United States Preventive Services Task Force, still in draft form, could change medical practice by making annual CT screening the standard of care for the highest-risk smokers.
And because insurers cover procedures strongly recommended by the task force, eligible patients would no longer have to bear the cost themselves. Under President Obama’s health care law, those who are eligible for the scan would have no co-pay. The procedure’s average price is about $170, according to the Advisory Board Company, a health care research firm in Washington, which polled oncology professionals.
Medicare would also begin reimbursing for the scan. A Medicare spokesman said the agency would not immediately comment on how much the new screenings could cost taxpayers.
The task force’s final recommendation will be issued three to six months after a public comment period, which ends on Aug. 26, a spokeswoman said.
Dr. Harold E. Varmus, the director of the National Cancer Institute, said the recommendation would "change the way people think about lung cancer.”
But he added that screening should not give smokers a false sense of security. "The main message is unchanged,” he said. "Don’t smoke.” Smoking is the culprit in about 85 percent of all lung cancer deaths.
The recommendation is aimed at a high-risk population of current and former smokers: about 10 million people ages 55 to 80 who have smoked at least a pack a day for 30 years, or the equivalent, even if they quit as long as 15 years ago, said Dr. Michael LeFevre, a professor of medicine at the University of Missouri and a member of the task force. The task force did not recommend screening for people who could not tolerate subsequent treatment, like surgery.
Using modeling, the task force estimated that the screening would prevent about 14 percent of the 160,000 lung cancer deaths per year, Dr. LeFevre said.
The low-dose CT scan being recommended has the potential to change the course of the disease by detecting it early enough for treatment to be effective.
The scan can detect much smaller tumors than chest X-rays can, said Dr. Mary Reid, an associate professor of oncology at the Roswell Park Cancer Institute in Buffalo.
"Imagine looking at a plum versus the end of your pen,” she said, describing the difference in size. "This kind of screening really shifts things to an earlier stage.”
But Dr. Kenneth Lin, a primary care physician who is also an associate professor of family medicine at the Georgetown University School of Medicine, was more cautious. "I’ll bring it up with patients,” he said of screening, "but I won’t necessarily push it hard.”
Dr. Lin noted that the National Cancer Institute study found the benefits of screening to be overwhelmingly among the highest-risk participants.
For the lower-risk participants, he said, the harms of early screening could outweigh the benefits. CT scans can pick up abnormalities that look like cancer but will not ultimately harm the patient, leading to unnecessary surgery or invasive tests like biopsies. The task force mentioned the potential harm of overdiagnosis but said it did not outweigh the benefits of screening in the target population.
Dr. Lin added that little was known about the cumulative risks of years of CT scans. The task force also noted the risk of radiation, but the number of lives saved by the screening would far outnumber the lives lost from cancers from radiation exposure.
Dr. Peter B. Bach, a pulmonologist at Memorial Sloan-Kettering Cancer Center in New York, said that the National Cancer Institute’s trial was conducted at top clinical research centers, where the scans and their interpretations were top-notch. But broader use of the scans in places with lower-quality medical care, he said, could lead to many more medical procedures that were not needed in the first place.
"This is going to be very hard to replicate in real life,” Dr. Bach said of the outcome of the trial.
Because the benefits of screening vary greatly depending on how much an individual has smoked, Dr. Bach has developed an online tool for people to assess whether they would be good candidates for screening.