The US Preventive Services Task Force (USPSTF) yesterday posted a draft recommendation statement on screening for lung cancer, advising that people who are at high risk for the disease receive annual low-dose CT scans. When used in the correct setting, these scans can prevent a substantial number of lung cancer–related deaths.
But deciding whether to be screened can be difficult. Even among a high-risk group, the risk of lung cancer varies between individuals. To help people determine whether screening will benefit them, Memorial Sloan Kettering has developed a lung cancer screening decision tool that is now available for use by the public.
The new decision tool is an online questionnaire that asks about lung cancer risk factors and is completely confidential. It can help people understand the likelihood that screening will be beneficial to them by first calculating the chance that a person will develop and die of lung cancer, and then figuring out how likely it is that screening will prevent this from happening.
The tool is appropriate for people fitting high-risk criteria similar (although not identical) to those described in the USPSTF recommendation. Those using the tool are asked to enter information such as age and smoking history based on pack years. (A pack year is calculated by multiplying the number of years an individual has smoked by the number of packs per day.)
“Our decision tool helps clinicians and patients determine the chance that screening will actually be helpful,” says Memorial Sloan Kettering epidemiologist and pulmonary and critical care physician Peter B. Bach, who helped develop the screening tool. “For those whose risk for developing lung cancer is not sufficiently high, a CT scan — even low dose — might do more harm than good, since it involves radiation exposure. The scans also can pick up abnormalities that wouldn’t cause harm but may lead patients to undergo unnecessary procedures.”
The screening decision tool was developed and tested by researchers at Memorial Sloan Kettering in collaboration with the Fred Hutchinson Cancer Research Center in Seattle. It is based on data from the Carotene and Retinol Efficacy Trial (CARET), a large, randomized trial of lung cancer prevention. CARET has been shown in other studies to be effective in predicting whether a person will develop lung cancer.
“For people who use this prediction tool, we advise them to discuss the results with their doctor,” Dr. Bach adds. “This is not meant to provide a definitive answer on whether to undergo screening but an important piece of information to guide a decision.”
Earlier this summer, Memorial Sloan Kettering launched a new Lung Cancer Screening Program that offers low-dose CT screening to current and former smokers who fit specific criteria in order to detect the disease at its earliest stage.