AATS Issues Lung Cancer Screening Guidelines

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.

SAN FRANCISCO – The American Association for Thoracic Surgery (AATS) Council approved new lung cancer screening guidelines at this year’s AATS Annual Meeting. A summary of the new "Guidelines for Lung Cancer Screening using Low Dose Computed Tomography (LDCT) Scans for Lung Cancer Survivors and Other High Risk Groups: Report of the AATS Lung Cancer Screening and Surveillance Task Force," was presented by Dr. Michael T. Jaklitsch.

Dr. Jaklitisch, a thoracic surgeon at Brigham and Women’s Hospital and an associate professor of surgery at Harvard Medical School, Boston, is the co-chair of the AATS Lung Cancer Screening and Surveillance Task Force along with Dr. Francine Jacobson, assistant professor of radiology at the hospital.

The AATS established the Lung Cancer Screening and Surveillance Task Force (LCSSTF) to create these guidelines for both smokers at high risk for lung cancer and lung cancer survivors in response to the publication of the National Lung Screening Trial (NLST), a randomized phase III trial, published in August 2011. The trial provided level 1 evidence that low-dose chest CT screening reduced lung cancer specific mortality by 20%.

Other societies such as the American Lung Association have also responded to the NLST trial with similar recommendations.

"Roughly 7 million out of 94 million current and former smokers in the United States meet the NLST criteria for highest risk screening. More than 75% of the positive screening tests resulted in additional testing, most frequently by repeat imaging. Less than 10% of the tests required an invasive procedure for further work-up," according to the Task Force.

The Task Force reported that the radiation exposure from LDCT appears to be negligible. They cited the fact that the average effective dose per scan in the NLST trial was 1.5 mSv and that the American Association of Physicists in Medicine, in a position statement on radiation risks from medical imaging procedures in December 2011, stated: "Risks of medical imaging at effective doses below 50 mSv for single procedures or 100 mSv for multiple procedures over short time periods are too low to be detectable, and may be nonexistent."

The Task Force also recommends the provision of care by an interdisciplinary team of thoracic surgeons working with radiologists, pulmonologists and oncologists. Such a team is "required to ensure decreased mortality from lung cancer outside of strict clinical trials in academic centers, including 0.5% operative mortality, and appropriate minimally invasive capabilities such as VATS."

The Task Force also indicated that it is "most desirable to create a program for lung cancer screening that also supports smoking cessation." Throughout the process there should be data gathered to "allow study of outcomes that are important for the practice of evidence-based medicine in the era of personalized health care."

In a summary statement of their new guidelines, the AATS recommended lung cancer screening for 3 distinct groups:

1) Level 1 evidence in favor of screening currently exists for North Americans between the ages of 55 and 79 with a 30 pack-year smoking history.

2) Lung cancer survivors are an extremely high risk group for developing a second lung cancer, and should be screened with LDCT starting 5 years after treatment.

3) Younger patients (age 50) with a 20 pack-year smoking history should be screened if they have an additional risk factor that produces a 5% risk of developing a lung cancer over the next 5 years. "At our current state of knowledge, that includes patients with documented radon exposure, occupational exposure, a lung cancer history in a first-degree relative if that cancer was recognized at a young age, COPD with an FEV1 of greater than 70%, and a tissue diagnosis of pulmonary fibrosis," according to the Task Force.

As costs are always of concern in proposing any new screening program, the Task Force discussed a recent estimate of the cost and benefit of annual lung cancer screening offered as a commercial insurance benefit for high risk Americans aged 50-64 years. That estimate found a screening cost of $1 per insured member per month in 2012 dollars.

The cost per life-year saved would be below $19,000. This compares favorably to cost per life-year saved in breast ($31,000 to $52,000), colon ($19,000 to $29,000), and cervical cancers ($50,000 to $75,000), the Task Force added.

The Task Force worked through an interdisciplinary consensus process, and its members were selected for their leadership in lung cancer screening, diagnosis, treatment, and follow-up of patient who have nodules and lung cancer. The fourteen individual members of the LCSSTF comprised: an epidemiologist, a pulmonologist, a pathologist, three medical oncologists, four thoracic radiologists, and four thoracic surgeons.

The idea of establishing a Task Force to create these consensus guidelines for the AATS was conceived by Dr. David J. Sugarbaker, chief of the Division of Thoracic Surgery at Brigham and Women’s Hospital. Other AATS members included on the Task Force are Dr. Shaf Keshavjee, director of the Toronto Lung Transplant Program at the University of Toronto, and Dr. Scott Swanson, professor of surgery at Brigham and Women’s Hospital.

The members of the Task Force reported no relevant disclosures.