Page 20 - Deleware Medical Journal - September/October 2019

while Delaware’s decline in lung cancer incidence and mortality is encouraging, U.S. rates of decline outpace those of Delaware. From 2001-2005 to 2011-2015, lung cancer incidence rates fell 10% in Delaware and 14% in the U.S. Over the same period, lung cancer mortality rates fell 19% in Delaware and 20% in the U.S.1
LOW-DOSE CT SCAN (LDCT) LUNG-CANCER SCREENING GUIDELINES
In 2011, the National Comprehensive Cancer Network (NCCN) developed guidelines for lung cancer screening with low-dose computed tomography (LDCT). NCCN guidelines, which are updated annually, are endorsed by the Delaware Cancer Consortium (DCC) and the Screening for Life (SFL) Program. Comprehensive in nature, NCCN guidelines include criteria to identify high-risk individuals, recommendations
for evaluation and follow-up of lung nodules detected via LDCT screening, and an overview of screening accuracy, 10 NCCN guidelines recommend annual LDCT screening for high-risk individuals who: (a) are 55 to 80 years of age; (b) have a smoking history equivalent to a pack a day for 30 years
or longer (calculated as number of packs smoked per day multiplied by number of years smoking); and (c) currently smoke or have quit smoking within the past 15 years.10 Per NCCN guidelines, individuals are also considered high risk if they: (a) are age 50 or older; (b) have a smoking history equivalent to a pack a day for 20 years or longer; and (c) have additional lung cancer risk factors other than second-hand smoke (e.g., radon exposure, occupational exposure, certain family and personal disease history) that increase the risk of lung cancer to > 1.3% using the Tammemagi lung-cancer risk calculator. Annual screening should be discontinued once a person no longer meets the
screening criteria, or develops a health problem that substantially limits life expectancy or the ability or willingness
to have curative lung surgery.10 Lung cancer screening with LDCT should take place in a quality screening facility with expertise in the procedure and, preferably, within the framework of an established lung-cancer screening program.11
Ideal screening facilities employ a multidisciplinary team with extensive experience in the evaluation, diagnosis, and treatment of lung cancer. If access to a quality lung-cancer screening program is not feasible, patients who wish to be screened with LDCT should be referred to a facility that performs a high volume of lung CT scans, diagnostic tests, and lung cancer surgeries.11
Data from the National Lung Screening Trial (NLST) showed that LDCT the rates of death from lung cancer and death from any cause.12 Adults at high risk
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