The International Association for the Study of Lung Cancer (IASLC) recently issued a statement on lung cancer screening with low-dose computed tomography (CT) based on the results of the Dutch-Belgian NELSON lung cancer screening trial presented at the IASLC 19th World Conference on Lung Cancer (WCLC).1 The IASLC Early Detection and Screening Committee, recognizing the importance of these results, now affirms the strength of evidence arising from two large, well-designed, and well-executed randomized trials that low-dose CT screening in high-risk individuals can significantly reduce lung cancer mortality.
Now is the time for international leaders, governments, health-care systems, and other stakeholders to implement global lung cancer screening programs as they do for breast cancer and colon cancer….— James L. Mulshine, MD
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“Given the confirmatory results of the NELSON screening trial along with the National Lung Screening Trial (NLST) findings, we now have additional evidence supporting the implementation of lung cancer screening,” said James L. Mulshine, MD, Chair of the IASLC Early Detection and Screening Committee. “The unanimous consensus of the committee’s screening experts is that now is the time for international leaders, governments, health-care systems, and other stakeholders to implement global lung cancer screening programs, as they do for breast cancer (mammography) and colon cancer (colonoscopy), which save the lives of countless individuals.”
More than 60% of lung cancers are diagnosed after the cancer has metastasized, leading to worse outcomes for patients. Early detection and diagnosis can lead to lowered mortality. Implementing a validated tool to reliably find early-stage, curable lung cancer is a priority of IASLC in its mission to conquer thoracic cancers worldwide.
Trial Findings
The NLST demonstrated that annual lung cancer screening with low-dose CT reduced lung cancer mortality by 20% and overall mortality by 7% compared with controls.2 Based on the NLST results, low-dose CT screening is now reimbursable under the Affordable Care Act in the United States for those at high risk (between the ages of 55 and 77 and a smoking history of ≥ 30 pack-years, who currently smoke or who have quit within the past 15 years3,4).
In data presented at the WCLC, the NELSON trial1 decisively confirmed that, compared with usual care, screening a high-risk population of current and formers smokers (aged 50–74, more than 10 cigarettes/d for more than 30 years or more than 15 cigarettes/d for more than 25 years) with low-dose CT can significantly reduce deaths from lung cancer by 26% in men and up to 61% in women.
Call for Global Lung Cancer Screening
Now that there are two trials (from both the United States and Europe) that demonstrate significant mortality reduction in high risk, tobacco-exposed populations, IASLC now endorses moving toward expanding this early-detection approach. IASLC also emphasizes that early detection must be routinely provided along with best-practice smoking cessation to enable optimal health outcomes in the setting of individuals who continue to consume tobacco products.
IASLC acknowledges that for implementation of low-dose CT screening worldwide, each national health service has the authority to decide its own course of action; yet it urges its members and others around the world to implement screening programs that incorporate a multidisciplinary group of experts and use best practice in screening care with focus on the following:
- Identification of high-risk individuals
- Acquisition of consistent high-quality images (from low-dose CT) and incorporation of radiologic guidelines, including definitions for positive vs negative results
- Use of defined clinical workup for indeterminate nodules and for pathology reporting of nodules
- Incorporation of a defined process for surgical or other diagnostic interventions of suspicious nodules
- Integration of smoking cessation into lung cancer CT screening programs.
“The current challenges to lung cancer screening, including lack of familiarity about the needs for low-dose CT by the primary care community and potential limitations with existing national health policies and systems, must be overcome,” said Dr. Mulshine. “IASLC will serve as a resource to help global implementation of economical and efficient screening services. With global confirmation of the lifesaving benefit from screening for lung cancer, we must move to educate and support lung cancer screening.” ■
REFERENCES
1. De Koning H, Van Der Aalst C, Ten Haaf K, et al: Effects of volume CT lung cancer screening: Mortality results of the NELSON randomized-controlled population based trial. 2018 World Conference on Lung Cancer. Abstract PL02.05. Presented September 25, 2018.
2. The National Lung Screening Trial Research Team: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365:395-409, 2011.
3. Moyer VA; U.S. Preventive Services Task Force: Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 160:330-338, 2014.
4. Centers for Medicare & Medicaid Services: Decision memo for screening for lung cancer with low dose computed tomography (CAG-00439N). Available at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274. Accessed October 29, 2018.
