Just last week, the US Preventive Services Task Force released a bulletin that issued a draft recommendation statement on screening for lung cancer. This is a big development since currently there is no recommended screening for lung cancer.
The US Preventive Services Task Force is a 16-member group that serves as an independent, volunteer panel of national experts in prevention and evidence-based medicine to improve the health of all Americans. These efforts are recommendations about preventive services such as screenings, counseling services, and preventive medications.
Since this announcement, there has been quite a stir. Have you heard this news? If you are in oncology, likely you heard it already. I have three times in the past week -- on the NPR station in my car, in my local newspaper, and again in my oncology professional trade publication email alerts. If you havenít heard yet, no worries, this will catch you up!
The draft recommendation outlines that a reasonable balance of risks and benefits are evident but still recommends a low-dose annual CT scan of the chest for those who are 55 to 80 years of age and have a recent or current 30-pack-per-year smoking history.
Smoking is the biggest risk factor for lung cancer development and is accountable for 85 percent of all lung cancers in the US. This proposed lung screening is an attempt to identify early signs of lung cancer. If a person has quit smoking they still must meet the 30-pack-per-year criteria and have quit smoking within the past 15 years. The risk for developing lung cancer of anyone who has stopped smoking greater than 15 years ago decreases each year.
There are almost 90 million smokers or former smokers in our country. With these proposed recommendations, about 7 million would qualify for this screening.
Each type of screening is given a grade. For instance, a mammogram for breast cancer screening has a grade of a B. This recent draft recommendation for lung cancer screening is the same grade.
Most grade A or B tests are covered by Medicare and other insurers. Colonoscopies for colon cancer and Pap smears for cervical cancer are both considered a grade A.
So whatís the stir all about? Well, itís about the number of scans and possible follow-up procedures that may not be necessary, beneficial, or even harmful. Some of these may include additional scans, added exposure to radiation, unnecessary bronchoscopies, biopsies, complications, etc. There is also concern if the screenings will cause over-diagnosis --uncovering other benign situations that will not cause any health problems but not provide a definitive diagnosis until additional testing is completed.
Many healthcare professionals and clinicians are split. This proposed recommendation is estimated to cut lung cancer deaths in the United States by 20,000 per year. This is roughly 13 percent of those 160,000 people who die of lung cancer each year. However, early detection may not mean survival.
If lung cancer is found through this newly recommended screening, it still may be too advanced in stage to make any real difference. And 96 percent of suspicious-looking nodules found via CT scan in the lung are non-cancerous. A point that clinicians need to caution on is how much faith they put into imaging. That is the other side of the controversy. And some believe some people will mistake this screening as a replacement for not quitting smoking.
Ironically, I live in a state with one of the highest percentages of lung cancer cases and deaths; Kentuckyís average is higher than the national average. This is likely due to the tobacco farming industry that has taken place here for decades.
Now is a great time to be an advocate. Make your viewpoint heard. We, as oncology nurses, see the good, bad, and ugly in all forms of cancer in all stages. We have the knowledge to share where it counts. Let the task force know your thoughts.
The task force is accepting public comments from now through August 26. An expected final recommendation will follow in three to six months afterward.