RSS Feeds
Lung Cancer Screening: Recommendation Statement
- U.S. Preventive Services Task Force*
- From the U.S. Preventive Services Task Force, Agency for Healthcare Research and Quality, Rockville, Maryland.
Abstract
This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer and the supporting scientific evidence and updates the 1996 recommendations on this topic. In 1996, the USPSTF recommended against screening for lung cancer (a grade D recommendation). The Task Force now uses an explicit process in which the balance of benefits and harms is determined exclusively by the quality and magnitude of the evidence. As a result, current letter grades are based on different criteria than those used in 1996. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the systematic evidence review on this topic, available through the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and the National Guideline Clearinghouse (http://www.guideline.gov). The complete USPSTF recommendation statement (which includes a brief review of the supporting evidence) and the summary of the evidence are also available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, ahrqpubs{at}ahrq.gov).
*For a list of the members of the U.S. Preventive Services Task Force, see the Appendix.
Summary of the Recommendation
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with either low-dose computerized tomography (LDCT), chest x-ray (CXR), sputum cytology, or a combination of these tests. This is a grade I recommendation. (See Appendix Table 1 for a description of the USPSTF classification of recommendations.)
The USPSTF found fair evidence that screening with LDCT, CXR, or sputum cytology can detect lung cancer at an earlier stage than lung cancer would be detected in an unscreened population; however, the USPSTF found poor evidence that any screening strategy for lung cancer decreases mortality. (See AppendixTable 2 for a description of the USPSTF classification of levels of evidence.) Because of the invasive nature of diagnostic testing and the possibility of a high number of false-positive tests in certain populations, there is potential for significant harms from screening. Therefore, the USPSTF could not determine the balance between the benefits and harms of screening for lung cancer.
Clinical Considerations
The benefit of screening for lung cancer has not been established in any group, including asymptomatic high-risk populations such as older smokers. The balance of harms and benefits becomes increasingly unfavorable for persons at lower risk, such as nonsmokers.
The sensitivity of LDCT for detecting lung cancer is 4 times greater than the sensitivity of CXR. However, LDCT is also associated with a greater number of false-positive results, more radiation exposure, and increased costs compared with CXR.
Because of the high rate of false-positive results, many patients will undergo invasive diagnostic procedures as a result of lung cancer screening. Although the morbidity and mortality rates from these procedures in asymptomatic individuals are not available, mortality rates due to complications from surgical interventions in symptomatic patients reportedly range from 1.3% to 11.6%; morbidity rates range from 8.8% to 44%, with higher rates associated with larger resections.
Other potential harms of screening are potential anxiety and concern as a result of false-positive tests, as well as possible false reassurance due to false-negative results. However, these harms have not been adequately studied.
The brief review of the evidence that is normally included in USPSTF recommendations is available in the complete recommendation statement on the USPSTF Web site (http://www.preventiveservices.ahrq.gov).
Recommendations of Others
Lung cancer screening recommendations from the American Cancer Society (1) can be accessed at http://www.cancer.org/docroot/PUB/content/PUB_3_8X_American_Cancer_Society_Guidelines_for_the_Early_Detection_of_Cancer_update_2001.asp. The policy of the American Academy of Family Physicians (2) can be accessed at http://www.aafp.org/x24974.xml. Recommendations from the Canadian Task Force on Preventive Health Care can be accessed through its Web site at http://www.ctfphc.org. Relevant guidelines on lung cancer screening from other organizations can be accessed through the National Guideline Clearinghouse at http://www.guideline.gov.
Appendix
Members of the U.S. Preventive Services Task Force are Alfred O. Berg, MD, MPH, Chair, (University of Washington, Seattle, Washington); Janet D. Allan, PhD, RN, CS, Vice-Chair (University of Maryland Baltimore, Baltimore, Maryland); Paul Frame, MD (Tri-County Family Medicine, Cohocton, and University of Rochester, Rochester, New York); Charles J. Homer, MD, MPH (National Initiative for Children's Healthcare Quality, Boston, Massachusetts); Mark S. Johnson, MD, MPH (University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey); Jonathan D. Klein, MD, MPH (University of Rochester School of Medicine, Rochester, New York); Tracy A. Lieu, MD, MPH (Harvard Pilgrim Health Care and Harvard Medical School, Boston, Massachusetts); C. Tracy Orleans, PhD (The Robert Wood Johnson Foundation, Princeton, New Jersey); Jeffrey F. Peipert, MD, MPH (Women and Infants' Hospital, Providence, Rhode Island); Nola J. Pender, PhD, RN (University of Michigan, Ann Arbor, Michigan); Albert L. Siu, MD, MSPH (Mount Sinai Medical Center, New York, New York); Steven M. Teutsch, MD, MPH (Merck & Co., Inc., West Point, Pennsylvania); Carolyn Westhoff, MD, MSc (Columbia University, New York, New York); and Steven H. Woolf, MD, MPH (Virginia Commonwealth University, Fairfax, Virginia). This list includes members of the Task Force at the time this recommendation was finalized. For a list of current Task Force members, go to http://www.ahrq.gov/clinic/uspstfab.htm.
Article and Author Information
-
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
-
Requests for Single Reprints: Reprints are available from the USPSTF Web site (http://www.preventiveservices.ahrq.gov) and in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (800-358-9295).
Related Clinical Content
