What are the recommended screening and intervention methods for researchers to reduce lung cancer risk in high-risk individuals?

From the Guidelines

For high-risk individuals, the most effective lung cancer screening method is annual low-dose computed tomography (LDCT) for adults aged 55-74 with a ≥30 pack-year smoking history and currently smoke or have quit within the past 15 years, as recommended by the U.S. Preventive Services Task Force 1 and the American Cancer Society 1.

Screening and Intervention Methods

The recommended screening method can detect lung cancer at earlier, more treatable stages, reducing mortality by approximately 20% 1.

• Smoking cessation is the most important intervention, with combination approaches showing best results:
  • Nicotine replacement therapy (patches, gum, lozenges)
  • Medications like varenicline (Chantix) or bupropion SR (Zyban)
  • Behavioral counseling
• Other risk reduction strategies include:
  • Radon testing in homes
  • Avoiding secondhand smoke
  • Limiting occupational exposures to carcinogens like asbestos and arsenic
  • Reducing air pollution exposure
  • Maintaining a healthy diet rich in fruits and vegetables

Implementation and Shared Decision-Making

Implementation should be personalized based on individual risk factors, with shared decision-making between patients and healthcare providers to discuss benefits, potential harms, and follow-up procedures 1.

• Clinicians should initiate a discussion about screening with apparently healthy patients who meet the screening criteria.
• A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening.
• Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer.

Prioritizing Morbidity, Mortality, and Quality of Life

The primary goal of lung cancer screening and intervention is to reduce morbidity, mortality, and improve quality of life for high-risk individuals.

• The recommended screening method and intervention strategies are based on the strongest and most recent evidence, prioritizing the reduction of lung cancer mortality and improvement of quality of life.
• The American Cancer Society recommends that screening should not be viewed as an alternative to smoking cessation, but rather as a complementary approach to reduce lung cancer risk 1.

From the Research

Recommended Screening Methods

• Low-dose computed tomography (LDCT) is recommended as a screening method for lung cancer in high-risk individuals, as it has been shown to reduce lung cancer mortality by 20% in high-risk smokers 2, 3, 4.
• The US Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years 2.

Intervention Methods

• The National Lung Screening Trial (NLST) found that three rounds of annual LDCT screening reduced lung cancer mortality by 20% compared to chest radiograph screening in high-risk current and former smokers aged 55 to 74 years 2.
• The Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial found that four rounds of LDCT screening with increasing intervals reduced lung cancer mortality by 24% compared to no screening in high-risk current and former smokers aged 50 to 74 years 2.
• A systematic review and meta-analysis of randomized controlled trials found that LDCT screening was associated with a statistically significant decrease in lung cancer mortality, with a pooled relative risk of 0.86 (95% CI 0.77-0.96) 5.

Harms of Screening

• The harms of LDCT screening include radiation-induced cancer, false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, and increases in distress 2, 4, 6.
• The estimated radiation-related lifetime attributable risk to develop cancer is below 0.25% for women and about 0.1% for men, assuming an annual LDCT screening of (ex-)smokers aged between 50 and 75 years 6.

Benefit-Risk Assessment

• The benefit-risk ratio of LDCT screening is estimated to be around 10 for women and 25 for men, assuming a mortality reduction of about 20% and taking only radiation risks into account 6.
• To ensure that the benefit outweighs the radiation risk, strict conditions and requirements must be established for the entire screening process to achieve a quality level at least as high as that of the considered randomized controlled trials 6.