Last fall researchers announced that a government-funded trial found screening current and former heavy smokers with low-dose CT scans reduced lung-cancer deaths by 20%. And yesterday, the details of that research were published in the New England Journal of Medicine . But the groundbreaking findings don’t mean that cancer groups have yet embraced a widespread screening program, or that every current and former smoker should run out and be scanned. In fact, the study authors say the current data alone aren’t enough to “fully inform” important questions about who should be screened, for how long and how. The American Society of Clinical Oncology is working with the National Comprehensive Cancer Network, the American Cancer Society and the American College of Chest Physicians to develop a clinical practice guideline for lung-cancer screening, ASCO said in a statement . “As with any screening tool, the benefits can be fully realized when the technology is accompanied by guidelines for appropriate use and follow-up, quality control, and insurance payment,” ASCO said. Figuring out appropriate use is a major issue, notes Reginald Munden, professor in the department of diagnostic radiology at M.D. Anderson Cancer Center and an investigator on the trial. This study included only people aged 55 to 74 who had a history of heavy smoking — defined as the equivalent of a pack a day for 30 years (or two packs a day for 15 years). Only about 7 million of the 94 million current and former smokers in the U.S. would meet the criteria used in the study. But what about people who are younger, or who have a history of fewer pack years? Ongoing studies with different criteria in other countries may eventually quantify the benefit. Until then, Munden tells the Health Blog he’d advise

current or former smokers with some history of smoking — 15 pack years or so — to discuss the risks and benefits of screening with a physician. Some of those people should probably be screened, he says, but caution is required, particularly with younger women, whose breasts are particularly vulnerable to the radiation produced by years of CT scans. (The scans used in the study were low-dose, but there is still some exposure.) It’s also not clear how to best do the screening and manage follow-up, especially with regard to the false positive readings that were common in the study. Though most false readings were sussed out with further imaging alone, some patients died from invasive follow-up procedures. “Managing abnormal findings and avoiding doing harm in individuals with false positive findings are among the major challenges we will confront,” noted the American Cancer Society’s chief medical officer, Otis Brawley, in a statement. No one likes to talk about cost, but it’s a big issue, and one that’s currently being analyzed. At this point, we know that screening and follow-up can be expensive, and with a limited pot of money, resources might be better spent on smoking cessation programs. The ACS estimates that quitting tobacco “will in ten years time reduce a smoker’s risk of death from lung cancer as much as CT screening did in this study,” Brawley said. That suggests resources shouldn’t be taken from smoking cessation efforts and redirected toward screening, he said. “This is a huge ray of hope for us to make a substantial impact on lung cancer,” says Munden. “But the biggest thing is not to smoke, or to stop.” Photo: Getty Images

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Lung-Cancer Screening Unknowns: Who Should Get it, How Much it Will Cost