COLUMBUS, Ohio ­– Two new studies published by investigators at The Ohio State University and the UNC Lineberger Comprehensive Cancer Center provide important evidence review and predictive modeling data to inform updated lung cancer screening guidelines implemented by the U.S. Preventive Services Task Force (USPSTF).

The studies and the new screening guidelines were published in the Journal of the American Medical Association (JAMA) on March 9.

USPSTF guidelines serve as an important benchmark for both eligibility and access to government- and private-payer insurance coverage of cancer screenings.

In these newly published studies, Daniel Jonas, MD, MPH, general medicine division director at The Ohio State University Wexner Medical Center, and former colleagues at the UNC Lineberger Comprehensive Cancer Center completed a comprehensive review of clinical trial registry data and peer-reviewed publications from the past 20 years to look at overall lung cancer incidence, lung cancer mortality, all-cause mortality, test accuracy and harms.

The first study was a review of 223 publications, including seven randomized clinical trials that evaluated lung cancer screening with low-dose computed tomography (CT) scan, or LDCT, including information from the National Lung Cancer Screening trial. In the second study, authors completed a modeling study to estimate benefits and harms associated with various LDCT screening strategies.

Study authors concluded that screening high-risk individuals with LDCT can reduce lung cancer mortality. They acknowledge that LDCT screening can also generate false-positive results, but they emphasize that, overall, utilization of LDCT screening for the early detection of lung cancer still results in reduced lung cancer-related deaths and life-years gained.

The authors also note that most clinical studies included in this review did not use current nodule evaluation protocols. Use of those protocols, they say, could reduce false-positive results and further improve the net benefit of screening.

“This points to the importance of following evidence-based, specific protocols for lung cancer screening to balance the benefits of early detection with the risk of potential additional invasive testing,” says Jonas, who served as corresponding author of one study and co-author of the other.

Lung cancer is the second most common cancer and the leading cause of cancer-related death among men and women in the United States. Most patients diagnosed with lung cancer present with advanced disease; only 20% are diagnosed with localized, stage 1 disease.

“I encourage anyone who is at increased risk for lung cancer due to their age and their current or past smoking history to have a conversation about lung cancer screening with their primary care physician to determine if it is right for them,” says Jonas, who sees patients at the Ohio State Wexner Medical Center.

Updated Screening Guidelines

In 2013, the USPSTF recommended annual screening for lung cancer with LDCT in adults of age 55 to 80 years who have a 30-pack-a-year smoking history and who currently smoke or have quit within the past 15 years. The USPSTF recommended that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or willingness to have curative lung surgery. The newly updated guideline recommends annual LDCT lung cancer screening for individuals of age 50 to 80 who have a 20-pack-a-year smoking history and currently smoke or have quit within the past 15 years.

Study authors noted that applying nodule management protocols and the use of risk-prediction models could improve the balance of benefits and harms, although limited published data is available to support this hypothesis.

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) Lung Cancer Program follows strict guidelines and algorithms to prevent unnecessary invasive testing procedures while increasing the potential of detecting lung cancers at their earliest stages, when both surgical and medical therapies are more likely to achieve cancer control. Patients who are screened have immediate access to radiology and pulmonary consults once the screening LDCT has been performed.

“These new lung cancer screening guidelines are much more inclusive, ensuring that the majority of high-risk patients will meet screening criteria. The onus now falls on us as providers to institute these guidelines, and on patients to address screening with their doctors,” says Michael Wert, MD, a pulmonologist and director of the OSUCCC – James Lung Cancer Screening Program. “Introduction of low-dose CT scans for lung cancer screening has truly saved lives through early detection, and it has the potential to save many more with this most recent change.”

Lung Cancer Screening and Primary Care Appointments

For more information about lung cancer screening at the OSUCCC – James, visit cancer.osu.edu/lungcancerscreening or call 1-800-293-5066.

To find an Ohio State University Wexner Medical Center primary care physician, visit wexnermedical.osu.edu.

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