Routine use of CT to screen for lung cancer risky

Routine use of CT to screen for lung cancer risky

Routine use of this unique tool on symptomless individuals is potentially hazardous

Photo: K.R. Deepak



Need for caution: Population based screening for lung cancer is not recommended and may, ultimately put the patient at risk for further complications. — .

The American College of Chest Physicians (ACCP) oppose the use of low dose computed tomography (CT) for general screening of lung cancer (EurekAlert, September 10).One hundred multi-disciplinary panel members developed and published the new evidence-based guidelines in a supplement to the September issue of CHEST, ACCP’s peer reviewed journal.

Mortality unaffected

Dr. W. Michael Alberts, Chief Medical Officer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, cautioned that even in high risk populations, currently available research data do not show that lung cancer screening alters mortality outcomes.

“Population [based] screening for lung cancer is not recommended and may, ultimately, put the patient at risk for further complications,” said Dr.Gene L. Colice, Director, Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, Washington DC and vice chairman of the ACCP lung cancer guidelines.

He clarified that during screening, physicians may commonly find nodules; however, to determine whether they are cancerous or not requires fairly invasive and extensive additional testing. The patient may have to face needless risk, both physically and psychologically.

‘Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition)’ contains 260 of the most comprehensive recommendations related to lung cancer prevention, screening, diagnosis, staging, and medical and surgical treatments. Some of these apply to computed tomography screening.

“There is little evidence to show that lung cancer screening impacts mortality in patients, including those who are considered at high risk for the disease” an ACCP press release asserted.

CT screening of symptom-free individuals is controversial. Peter B. Bach and his co-workers analysed lung cancers in 3,246 asymptomatic current or former smokers screened for lung cancer from two academic centres in the U.S. and one in Italy and found that screening for lung cancer with low dose CT may increase the rate of lung cancer diagnosis and treatment, but may not meaningfully reduce the risk of advanced lung cancer or deaths from lung cancer (JAMA, March, 7).

They argued that until more conclusive data are available, asymptomatic individuals should not be screened outside clinical research studies that have a reasonable likelihood of further clarifying the potential benefits and risks.
Conclusions opposed

These results contradict the conclusions of the International Early Action Lung Cancer Programme, which claimed that CT screening of high risk individuals could prevent 80 per cent of lung cancer deaths (New England Journal of Medicine, 2006).

After reviewing these two papers, Drs William C. Black and John A. Baron concluded thus: “Although expensive and time consuming, rigorous trials for cancer screening are far more cost-effective than what might be the alternative — widespread adoption of costly screening interventions that cause more harm than good” (JAMA, March, 7, 2007).

The unambiguous ACCP guidelines must settle the issue. The ACCP Thoracic Oncology NetWork, the Health and Science Policy Committee, the Board of Regents, and external reviewers from the journal CHEST reviewed and approved these guidelines.

The American Association for Bronchology, American Association for Thoracic Surgery, American College of Surgeons Oncology Group, American Society for Therapeutic Radiology and Oncology, Asian Pacific Society of Respirology, Oncology Nurses Society, Society of Thoracic Surgeons, and the World Association of Bronchology also endorsed them.

Over 2,200 CT scan units are used in India. These are beneficial tools only in clinically indicated diagnostic tests.

Each CT scan exposes patients to radiation doses equal to a few hundreds of chest x-ray examinations. Routine use of this unique tool on symptomless individuals is potentially hazardous.
Panel of specialists

Professional associations in India must develop robust guidelines. In the absence of such efforts, the Health Ministry must urgently set up a panel of specialists with representatives from Indian Council of Medical Research, the Atomic Energy Regulatory Board and professional associations to review the ACCP recommendations and other similar guidelines.

The panel may be asked to examine the applicability of these guidelines in the Indian context and make appropriate recommendations.

K.S. PARTHASARATHY

Former Secretary, AERB
( ksparth@yahoo.co.uk)

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