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Lung Cancer Guidelines Withhold Endorsement of CT Screening


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Lung Cancer Guidelines Withhold Endorsement of Computer-Assisted Tomography Screening: Presented at NCCN

By Ed Susman

HOLLYWOOD, Fla. -- March 10, 2008 -- Support of computer-assisted tomography (CT) screening for lung cancer in high-risk groups is being withheld by the Non-Small-Cell Lung Cancer (NSCLC) Guidelines Committee of the National Comprehensive Cancer Network (NCCN).

The Committee announced the decision on March 6th here at the NCCN's 13th Conference on Clinical Practice Guidelines and Quality Cancer Care. A recommendation is pending the outcome of an ongoing government-sponsored study of CT screening.

"We don't recommend screening routinely," said David S. Ettinger, MD, Alex Grass Professor of Oncology, as well as Professor of Medicine, Otolaryngology, Head and Neck Surgery, Obstetrics & Gynaecology, and Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Previous studies had problems with their methodology, so the committee is waiting for a large, ongoing, well-designed, clinical study that should answer the question of whether screening allows for early detection of lung cancer, and does early detection translate into life-saving early intervention, Dr. Ettinger said.

"We prefer that patients be put on a clinical-trial protocol to answer the question of whether screening can save lives," Dr. Ettinger added.

The guidelines include references to published studies, including that of Claudia Henschke and colleagues (N Engl J Med. 2006;355:1763-1771), which appears to indicate that screening finds cancers early enough so that surgery is possible and patients achieve long-term survival.

"We all await the national study, which is due to be published in 2009, for the routine use -- if the study is positive -- of spiral CT for screening," Dr. Ettinger said.

The statement on screening in the 2008 NSCLC guidelines currently reads as follows: "At the present time, the NCCN panel does not recommend the routine use of screening CT as standard clinical practice despite the recent data from the International Early Lung Cancer Action Program (I-ELCAP) demonstrating that lung cancer screening can detect Stage 1 lung cancer, which could translate [to] an increase in survival of lung-cancer patients."

Dr. Ettinger said the statement generated unresolved, strong disagreements among the panelists and, therefore, received a "Category 3" criterion -- which means the panel could not reach consensus on the statement.

Instead, 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."

[Presentation title: Update: Non-Small Cell Lung Cancer Guidelines.]

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