Routine lung cancer screening not advised

Wed Sep 12, 8:32 PM ET
Guidelines released Monday by the American College of Chest Physicians (ACCP) indicate that at present lung cancer screening with CT scanning and other methods is generally not warranted outside of research studies.
In a larger, accompanying report, the group lists 260 recommendations that should be followed in the prevention, screening, diagnosis, staging, and treatment of lung cancer. Both sets of guidelines are published in a supplement to the journal Chest.
After reviewing previous study findings, the research team, led by Dr. Peter B. Bach, from Memorial Sloan-Kettering Cancer Center in New York, concludes that screening with CT imaging or certain sputum tests, simply does not reduce lung cancer deaths, even in high-risk groups, such as heavy smokers.
According to the investigators, one of the problems is that current research on CT and sputum screening has focused primarily on lung cancer detection rates, not on whether patient outcomes are actually improved. Studies addressing this question are underway, but the answers will not be available for years.
Based on a lack of solid evidence supporting the following practices, the group makes three recommendations:
--Do not use CT to screen for lung cancer outside of trial settings.
--Do not use chest X-rays to screen for lung cancer.
--Do not use sputum tests to screen for lung cancer.
"Population screening for lung cancer is not recommended and may, ultimately, put the patient at risk for further complications," Gene L. Colice, vice-chair of the ACCP lung cancer guidelines, said in a statement.
The guidelines also advise against the use of vitamins, particularly beta-carotene, vitamin A, and vitamin E, as a means of preventing lung cancer. In the case of beta-carotene, use of this vitamin may actually increase the risk of the cancer.
According to the report, there is also no solid evidence that aspirin helps prevent lung cancer or reduces lung cancer deaths.
By contrast, for the first time, the guidelines support the use of certain alternative treatments as in addition to conventional therapy. Massage therapy is recommended when anxiety or pain is present, and acupuncture is advised for fatigue, shortness of breath, and poorly controlled nausea and vomiting.
SOURCE: Chest, September 2007.