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The best way to prevent lung cancer is to quit smoking or never start, but the next best thing is early diagnosis. Taking a giant leap toward catching lung cancer in its earliest stage, the U.S. Preventive Services Task Force (USPSTF; Washington) has issued a draft recommendation giving its second highest approval rating for routine CT screening for those at high risk for lung cancer.

The grade B recommendation was widely applauded by organizations such as the Lung Cancer Alliance (LCA; Washington), the American College of Radiology (ACR; Reston, Virginia), and Prevent Cancer Foundation (Alexandria, Virginia). Experts say the move, if approved in final form, will trigger Medicare and insurance coverage and bring about a dramatic drop in the leading cause of cancer deaths. The Affordable Care Act requires that Medicare and private insurers provide coverage of all exams or procedures that receive a grade of "B" or higher from the USPSTF.

As many as 20,000 deaths a year could be prevented by screening, according to Michael LeFevre, MD, co-vice chair of the task force and a family physician. Public comments will be taken until Aug. 26, then the panel will give its final recommendation.

"It's important to remember that helping smokers stop smoking and protecting non-smokers from exposure to tobacco smoke are the most effective ways to decrease the sickness and death associated with lung cancer," LeFevre said. "In addition, people who quit smoking will continue to see their risk go down over time. Screening for lung cancer is beneficial, but it is not an alternative to quitting smoking."

LCA President/CEO Laurie Fenton Ambrose said the implications of the favorable "B" rating are profound and a "monumental moment."

"Tens of thousands of lives could be saved," she said. "Screening those at high risk now will dramatically make a difference and will open the door to much faster advances in research on all stages of lung cancer. This is a game changer."

The USPSTF recommends screening for current and former smokers age 55 to 80 with a smoking history the equivalent of smoking a pack a day for 30 years or two packs a day for 15 years. The recommendation for screening includes those who have quit within the past 15 years.

This age range may be too narrow, according to Legacy (Washington), a group that says it supports the task force recommendations but disagrees with some of the specifics. "This is a significant step in the right direction but there is more to be done," said Cheryl Healton, president/CEO of Legacy. Still, she emphasized Legacy's "overwhelming support for the USPSTF's endorsement of early screening for lung cancer as a watershed moment sure to save hundreds of thousands of lives."

Healton said Legacy will use the public comment process to address the issues that it would like to see strengthened.

The LCA noted that the most important next steps are to educate the public and direct them to responsible screenings. To that end, the LCA launched a Risk Navigator tool,, and expanded the hours of its support line, (800) 298-2436. LCA says it will also launch a national educational advertising campaign in September to encourage the public to know their lung cancer risk.

Likewise, Legacy offers tools and information to support smokers as they quit through its bilingual smoking cessation program.

The recommendation is expected to be finalized within six months.

According to the LCA, lung cancer is the leading killer in the U.S., taking 160,000 lives a year. Only 15% of people diagnosed with lung cancer will live five years or longer, primarily because the vast majority of lung cancers are diagnosed at a late stage.

One concern about the recommendation is that people will see it as a pass to continue smoking. Peter Bach, MD, at Memorial Sloan-Kettering Cancer Center (New York) said he doesn't think that's likely though, because people know how harmful smoking is.

Smoking is the biggest risk factor for developing lung cancer, resulting in about 85% of lung cancers in the U.S., the USPSTF noted. The risk for developing lung cancer also increases with age, with most lung cancers occurring in people age 55 or older.

"The more you smoke over time, the more at risk you are for lung cancer. When deciding who should be screened, clinicians will need to assess the person's age, overall health, how much the person has smoked, and whether the person is still smoking or how many years it has been since the person quit," LeFevre said. "This evaluation will help clinicians decide whether it may be beneficial to screen a given person."

The task force's draft recommendation statement has been posted for public comment at

The ACR said it supports the recommendation but noted that evidence-based infrastructure must be put in place across the country to ensure that patients have access to uniform, quality care and a similar benefit from these exams.

"Expanded use of CT lung cancer screening in high risk patients is a landmark step in the battle to defeat this terrible disease," said Paul Ellenbogen, MD, chair of the ACR board of chancellors. The ACR is developing practice guidelines and appropriateness criteria that address how lung cancer screening CT exams are performed, interpreted and how the results are communicated.

The risk of developing lung cancer goes down gradually after a smoker quits but it never returns to the level of a 'never smoker.' Many smokers who have quit and remained smoke-free for more than 15 years can benefit from CT screening too, especially those with a family history of lung cancer.

Another advocacy group, Prevent Cancer Foundation, also applauded the USPSTF's recommendation. "The task in front of us is to work together to ensure this screening service is provided in a safe, economical and effective fashion across the country," said James Mulshine, MD, scientific director and vice chairman of the Prevent Cancer Foundation board of directors.

Amanda Pedersen, 912-660-2282;

Published  July 31, 2013

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