STATEMENT OF THE AMERICAN COLLEGE OF RADIOLOGY (ACR) ON THE NATIONAL LUNG CANCER SCREENING TRIAL (NLST)
Lung cancer, most frequently caused by cigarette smoking, is the leading cause of cancer-related deaths in the United States – claiming nearly 160,000 lives each year. The most effective way to avoid lung cancer death is not to start smoking, and if you already smoke, to quit immediately and permanently.
As a medical association representing nearly 34,000 health care providers dedicated to saving and extending lives, the American College of Radiology (ACR) fully supports the use of techniques shown to significantly reduce the number of people who die each year from lung cancer. The National Lung Cancer Screening Trial (NLST) was stopped early so that the tremendous positive results could be made known. This speaks volumes to the ability of helical computed tomography (CT) screening of high-risk patients to save lives.
The significant number of lives saved should be the primary factor in decisions regarding the widespread use of CT screening for lung cancer. In that regard, important areas of discussion for determining the direction of any national policy include the following:
The radiation dose cited in the trial, 20 percent of that of a normal chest CT scan, is encouraging. Each successive generation of scanner consistently enables better images to be taken with lower doses. Imaging providers continue to strive to optimize dose for each patient based on a number of factors. As the dose required to obtain medical images is reduced, this becomes less challenging. Any screening program would have to address when and how often to screen taking these factors into account.
Any new screening program to be paid for by Medicare would require an act of Congress to accomplish. The NLST researchers have indicated that a cost-effectiveness study regarding the use of CT for lung cancer screening may be forthcoming in the next 12 months. This would be a significant factor in the formulation of any lung cancer screening program. Private insurers will likely do their own cost effectiveness assessment of large-scale lung cancer screening policy.
Widespread screening may also result in false positive (abnormalities detected that ultimately prove not to be cancer) and in heightened anxiety among patients awaiting exam results. All of these factors must be weighed against the significant reduction in lung cancer deaths that CT screening has been shown to provide among these patients.
As the expert organization in this area of care, the ACR is very encouraged by the NLST results. The College looks forward to working with the U.S. Department of Health and Human Services, the National Cancer Institute, patient advocacy groups, Congress and other stakeholders in addressing challenges to a potential lung cancer screening program.
Until and unless a national lung cancer screening program can be put in place, we encourage all physicians to obtain as much information regarding the NLST as possible. We also encourage patients to speak with their doctors regarding the usefulness of CT scanning to screen for lung cancer in their particular cases.
Director of Public Affairs
American College of Radiology