Doctors Just Say "No" to Lung Cancer Screening - F

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Presented at NCCN

http://www.docguide.com/news/content.ns ... A3006D19C4

By Ed Susman

HOLLYWOOD, FL -- March 19, 2007 -- The concept of screening smokers and former smokers for lung cancer using computed tomography (CT) was turned down by doctors writing new guidelines for treatment and prevention of lung cancer.

Instead, doctors agreed to wait until the results of a randomised, clinical trial are reported in 2009 to determine whether the screening procedure actually is life-extending, they said in a presentation here at the 12th annual meeting of the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines and Quality Cancer Care conference.

The new lung cancer guidelines were discussed by David Ettinger, MD, the Alex Grass Professor of Oncology and professor of medicine, otolaryngology-head and neck surgery, obstetrics and gynaecology, and radiation oncology, and molecular radiation sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.

"Our decision was designated a category 3 decision, which means there was considerable disagreement within the committee, and that disagreement was not resolved," Dr. Ettinger explained in his presentation on March 15th.

Studies indicating a benefit to early diagnosis and treatment of early-stage lung cancer discovered in CT-screening demonstration projects are rife with possible biases since the studies are not randomised.

"We had a lot of disagreement on the committee on this subject," Dr. Ettinger said, but the committee finally agreed on a statement:

"At the present time, the NCCN does not recommend the screening CT as standard clinical practice (category 3) despite recent data from I-ELCAP (International Early Lung Cancer Action Program) demonstrating that lung cancer screening can detect stage 1 lung cancer, which could translate to an increase in survival of lung cancer patients," he said

"The panel recommends that high-risk individuals participate in a clinical trial evaluating CT screening. If a trial is not available or the high-risk individual is not eligible for participation in a trial, then the individual should go to a centre of excellence with expertise [in radiology, pathology, cytology, thoracic surgery and general expertise in lung cancer treatment] to discuss the potential risks and benefits before having a screening CT," Dr. Ettinger said.

A major government-sponsored study on the impact of screening has finished accruing subject and definitive results will be reported in 2009, at which time the NCCN recommendations will be reviewed.

Data from I-ELCAP indicated that patients who underwent screening and had surgery to remove the early lung tumour had a 10-year survival rate of 92%. Researchers concluded that CT screening could detect early-0stage cancer that was curable (NEJM 2006; 355:1763-71).

Dr. Ettinger said the trial's methodological flaws included the fact that I-ELCAP is a case-control observational study that was not randomised, it had no long-term follow-up, no planned management for all participating institutions and the enrolment criteria were institution specific.