CT Screenings Can Reduce Lung Cancer Mortality

A study published in the New England Journal of Medicine, focused on data from 13,195 men and 2,594 women aged 50 to 74 years old who were heavy smokers, found that participants had a lower mortality if they were screened with computed tomography (CT).

All individuals were followed for a minimum of 10 years and each was randomly assigned to get either low-dose CT scans at baseline, a year, three years and 5.5 years, or no screenings at all. Participants who were screened had lower death rates than the control group: 24% lower for men and 33% lower for women.  The overall referral rate for suspicious nodules was 2.1%.

A U.S. trial of nearly 54,000 heavy smokers in 2011 also found a 20% drop in lung cancer deaths via screenings with CT in comparison to chest X-rays. 

Following the U.S. study, the U.S. Preventive Services Task Force recommended low-dose CT screening for people aged 55 to 80 who had a history of smoking equal to a pack a day for 30 years and were either still smoking or had quit within the past 15 years. 

The American Cancer Society states that lung cancer is responsible for 25% of all cancer deaths and estimates that 72,500 men and 63,220 women in the U.S. are expected to die of lung cancer in 2020

USPSTF breast cancer screening guidelines

The United States Preventative Services Task Force (USPSTF) issued new guidelines for when and how often women should be screened for breast cancer.

The USPSTF recommends biennial screening mammography for women 50-74 years.  Women of average risk between the ages of 40 and 49 should make an individual choice about whether to initiate screening every other year.  The UUPSTF recommends against teaching self-breast examination.

       

The USPSTF’s recommendations are similar to those issued recently by the American Cancer Society.  ACR recommends initiation of annual screening at age 45 and transition to biennial at age 55 as long as a woman has life expectancy of 10 years or longer.

American Cancer Society Updated Guidelines for Breast Cancer Screening

Breast cancer is a leading cause of premature mortality among US women.   Oeffinger at al report in JAMA the American Cancer Society (ACS) 2015 update regarding the frequency of screening mammography in women at average risk. 

The ACS recommends that women with an average risk of breast cancer should undergo annual screening mammography starting at age 45 years (strong recommendation).

Women 55 years and older should transition to biennial screening (strong recommendation).

Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation).

Women should have the opportunity to have annual screening between at the ages of 40-45 received a qualified recommendation.

The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age (qualified recommendation).

These updated ACS guidelines provide evidence-based recommendations for breast cancer screening for women at average risk of breast cancer.   

CMS approves CT Lung Cancer Screening

The Centers for Medicare and MedicaidServices on February 6, 2015 issued its final decision approving Medicare coverage for lung cancer screening by low-dose CT.  Medicare will cover annual screenings for beneficiaries aged 55-77 who are current smokers or who quit in the last 15 years, and who have a history of at least 30 “pack years.”   According to the American Cancer Society, lung cancer kills nearly 158,000 patients a year.

Screening for Breast Cancer

Screening for Breast Cancer; recommendations from medical societies and boards.

1.  US Preventive Services Task Force (USPSTF)

In 2009, in light of evidence that the benefit-risk ratio is higher among women older than 50 years and with less frequent screening, the USPSTF reversed its previous recommendation of mammography every 1 to 2 years beginning at age 40 years and recommended routine screening every 2 years starting at age 50. This was consistent with recommendations in many European countries.

The USPSTF stated that “the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient’s values regarding specific benefits and harms.”

2.  American Cancer Society

·      Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health

·      Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over

·      Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.

Some women because of their family history, genetic mutations, or other factors, MRI should be added to their screening. The number of women who fall into this category is small: less than 2% of all the women in the US.

3.  Swiss Medical Board

In January 2013, the SwissMedical Board, an independent health technology assessment initiative under the auspices of the Conference of Health Ministers of the Swiss Cantons, the Swiss Medical Association, and the Swiss Academy of Medical Sciences, was mandated to prepare a review of mammography screening.

Based on existing literature the board recommended that no new systematic mammography screening programs be introduced and that a time limit be placed on existing programs. In addition, it stipulated that the quality of all forms of mammography screening should be evaluated and that clear and balanced information should be provided to women regarding the benefits and harms of screening.

The Swiss Medical Board is nongovernmental body, and its recommendations are not legally binding.

References:

American College of Radiology Practice Guideline for Screening and Diagnostic Mammography  

American Cancer Society
Swiss Medical Board