Heidi Roberts1, Cindy Walker-Dilks, Khalil Sivjee, Yee Ung, Kazuhiro Yasufuku, Amanda Hey, Nancy Lewis. 1. *Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Women's College Hospital, Toronto, Ontario, Canada; †Department of Oncology, McMaster University, Hamilton, Ontario, Canada; ‡Division of Respirology and §Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ‖Division of Thoracic Surgery, Toronto General Hospital, Toronto, Ontario, Canada; ¶Northeast Cancer Centre, Health Sciences North, Sudbury, Ontario, Canada; and #Cancer Care Ontario, Prevention and Cancer Control, Toronto, Ontario, Canada.
Abstract
INTRODUCTION: The aim of this practice guideline was to develop evidence-based recommendations for screening high-risk populations for lung cancer. METHODS: The guideline was developed using the methods of Cancer Care Ontario's Program in Evidence-Based Care. The core methodology of the Program in Evidence-Based Care's guideline development process is systematic review. A systematic review had recently been completed by a collaboration of the American Cancer Society, the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. The evidence from that systematic review formed the basis of the recommendations, which were reviewed, and amended where necessary, by clinical experts in the fields of medical and radiation oncology, radiology, lung disease, and population health. RESULTS: The systematic review included eight randomized controlled trials and 13 single-arm studies evaluating screening with low-dose computed tomography (LDCT) in patients at risk for lung cancer. One large randomized trial reported a statistically significant reduction in lung cancer mortality with LDCT at 6 years compared with chest radiography. The practice guideline recommendations generally align with the parameters of the National Lung Screening Study. Deviations were described and justified by the guideline working group. The recommendations support screening persons at high-risk for lung cancer with advice for determining a positive result on LDCT, appropriate follow-up, and optimal screening interval. CONCLUSION: The benefits of screening high-risk populations for lung cancer with LDCT outweigh the harms if screening is implemented in a strictly controlled manner.
INTRODUCTION: The aim of this practice guideline was to develop evidence-based recommendations for screening high-risk populations for lung cancer. METHODS: The guideline was developed using the methods of Cancer Care Ontario's Program in Evidence-Based Care. The core methodology of the Program in Evidence-Based Care's guideline development process is systematic review. A systematic review had recently been completed by a collaboration of the American Cancer Society, the American College of Chest Physicians, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network. The evidence from that systematic review formed the basis of the recommendations, which were reviewed, and amended where necessary, by clinical experts in the fields of medical and radiation oncology, radiology, lung disease, and population health. RESULTS: The systematic review included eight randomized controlled trials and 13 single-arm studies evaluating screening with low-dose computed tomography (LDCT) in patients at risk for lung cancer. One large randomized trial reported a statistically significant reduction in lung cancer mortality with LDCT at 6 years compared with chest radiography. The practice guideline recommendations generally align with the parameters of the National Lung Screening Study. Deviations were described and justified by the guideline working group. The recommendations support screening persons at high-risk for lung cancer with advice for determining a positive result on LDCT, appropriate follow-up, and optimal screening interval. CONCLUSION: The benefits of screening high-risk populations for lung cancer with LDCT outweigh the harms if screening is implemented in a strictly controlled manner.
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