Summarized by the National Guideline Clearinghouse (NGC):
The American Cancer Society does not recommend lung cancer screening for asymptomatic individuals at risk for lung cancer. However, individual physicians and patients may decide that the evidence is sufficient to warrant the use of screening tests on an individual basis.
In the past few years however, results from screening studies using spiral computed tomography (CT) have been regarded as sufficiently encouraging to lead a growing number of institutions and facilities to promote computed tomography screening to asymptomatic individuals at risk for lung cancer, with such promotion likely to increase. Since both media reports and local advertising may stimulate interest in spiral computed tomography testing among health care providers and individuals at higher risk, the American Cancer Society has determined that updated guidance about early lung cancer detection is appropriate. Further, given the high rate of positive results that occur with computed tomography screening for lung cancer and the complexity of the algorithm for working up small nodules, there is reason to be concerned about broad dissemination of lung screening outside of experienced, multi-specialty settings and prior to validation of this new technology.
For this reason, it is critically important during this period of evolving investigations into the efficacy of spiral computed tomography and other modalities that appropriate and influential professional organizations provide a foundation for best practices based upon the current state-of-the-art, and also promote informed decision-making for patients about possible benefits, risks, and limitations of testing for early lung cancer detection. Individuals interested in early detection also should be encouraged to participate in trials.
The American Cancer Society recommends that, to the extent possible, individuals at risk for lung cancer due to current or prior smoking history, history of significant exposure to second-hand smoke, or occupational history, be aware of their continuing lung cancer risk. Those who seek testing for early lung cancer detection should be informed about what is currently known about the benefits, limitations, and risks associated with conventional and emerging early detection technologies, as well as the associated diagnostic procedures and treatment.
Given the complexity of diagnostic and follow-up algorithms associated with early lung cancer testing, the American Cancer Society discourages testing in a setting that is not linked to multidisciplinary specialty groups for diagnosis and follow-up. Individuals who choose to undergo testing should have access to testing and follow-up that meet state-of-the-art standards, with informed decision-making at every step of an ongoing process. Ideally, the route to testing should be through an individual's primary care physician, who should be prepared to help patients understand their risks and reach informed decisions about testing, and to provide support if early detection tests are positive. Absence of a referral from a primary care physician due to lack of provider endorsement of testing, or not having a primary care provider, should not be a barrier to testing. However, if an individual seeks testing and does not have a referral from a primary care provider, the radiologist who provides testing is obliged to provide information about benefits, risks and limitations of testing as described above, and must become the individual's physician of record until proper alternative care arrangements can be made. Individuals who are current smokers also should be informed that the more immediate preventive health priority is the elimination of tobacco use altogether, since smoking cessation offers the surest route at this time to reducing the risk of premature mortality from lung cancer.
