The other screening story

One of the top stories to catch my eye this week has triggered a discussion on whether recommendations for screening should be adjusted. And it has nothing to do with mammography.

Yes, the American Cancer Society probably had the biggest headlines this week when it issued new recommendations for screening mammography that said routine annual mammograms for average-risk women can wait till 45, as opposed to the age 40 threshold previously prescribed.

Many in the imaging community had strong thoughts on the matter.

But another study that went a little under the radar given the ACS announcement was a study in the Journal of the National Cancer Institute that suggests lung cancer screening recommendations might need to be shifted as well.

Based on the results of the National Lung Screening Trial, the U.S. Preventive Services Task Force has recommended the eligibility for low-dose CT lung cancer screening be limited to those with at least a 30 pack-year smoking history (an average of a pack of cigarettes per day for 30 years).

The new study, however, found the risk of lung cancer among 20- to 29-pack-year current smokers was similar to that of the 30-pack-year crowd. Moreover, current 20- to 29-pack-year smokers are more likely to be female and to be racial/ethnic minorities, meaning current recommendations could lead to disparities in screening access.

As with the mammography debate, one study alone won’t cause a sea change in practice, and there will likely be continued debate over which patients make the best candidates for CT lung cancer screening.

Even study authors Paul Pinsky, PhD, and Barnett S. Kramer, PhD, of the National Cancer Institute, noted that shorter-term smokers were not included in the National Lung Screening Trial, and wrote that there “is the untested assumption that the trial’s mortality benefit can be extrapolated to them.”

It will certainly be an interesting question to follow as more research is conducted.

-Evan Godt
Editorial Director