Posted: September 9, 2021

In 2006 the classic ELCAP trial was published showing a dramatic lowering of mortality from lung cancer in current and recent former smokers, those with industrial carcinogenic exposure and those with significant second-hand smoking exposure.   This set off a mad scramble to confirm and extend these observations;  the European Screening trial and the National Lung Screening Trialand eventually led the US Preventive Services Task Force to recommend low-dose CT scanning for people at high risk for lung cancer.   These recommendation have been tweaked over the last eight  and have eventuated in the current guidelines promulgated by the USPSTF in May 2021.  Click here for the article supporting this stance published .  As of September 2021, JAMA is still offering the full article.  If they stop doing this Dr. Stark will send it to you if you request it in the box to the right.   The essence of the recommendation is a lowering of the age of first screening from 55 to 50 and a lowering of the pack-years of smoking to justify screening from 30 to 20.  Recall a pack year is the number of years smoking times the average number of packs per day smoked.  After fifteen years of smoking cessation, according the to task force the excess risk of cancer stops, although not all experts agree (Drs. Doll and Peto from England, great epidemiologists in their own right, believe the risk never returns to baseline). The age at which screening should stop is either 80 or earlier if other health issues intervene.

Dr.  Stark weighs in.  “The orignial ELCAP study was a game changer.  Until then no one had shown that frequent screening chest xrays could reduce lung cancer mortality, and there was a great deal of nihilism about surveillance in smokers.  Using low-dose spiral CT (keeping the cumulative radiation exposure over years to decades very low) changed the story.  The rest is tweaking.  Sadly, as commented upon in the accompanying editorial, only a tiny percentage of Americans — at most 16% —  who could benefit from this approach are taking advantage of it.  The percentage of minorities who submit to screening is even lower.  No doubt screening results in lots of biopsies for benign disease, but the reduction in mortality — from 90% in the unscreened, to 20% in the screened and 5% in the screened who go on to surgery — is staggering.  Kudos to USPSTF for keeping this issue in front of us.”