Key Point

A new position statement resulting from the 2003 Como International Conference on lung cancer screening has concluded that screening for lung cancer is a reasonable strategy for high-risk individuals.

PROVIDENCE, RI—A new position statement resulting from the 2003 Como (Italy) International Conference on lung cancer screening represents what could be an important step toward recommending such screening for those at high risk of lung cancer. The statement asks physicians to discuss the current state of knowledge about lung cancer screening with high-risk individuals—a measure that has never before been advised.¹

“However, the statement stops short of recommending screening for those patients,” principal author Gary M. Strauss, MD, told Pulmonary Reviews. “But we do say that, after talking with their physician, it is reasonable for them to seek testing for lung cancer.”

Whether the statement will influence the American Cancer Society and other cancer organizations to recommend lung cancer screening is uncertain, acknowledged Dr. Strauss, an Associate Professor of Medicine at the Brown University School of Medicine in Providence, Rhode Island. Citing a lack of scientific proof of a benefit, those organizations have consistently recommended against lung cancer screening, and such screening remains uncommon outside of clinical trials.

The new statement defines high-risk individuals as those older than 45 to 50 who are current or former smokers with 20 to 30 pack-years of cumulative cigarette consumption and no life-limiting comorbidities. These individuals should be informed about their risk of lung cancer and about what is known and unknown regarding the benefits and limitations of screening for the disease, the statement says. Among the most important specific points to make regarding screening:

• Whenever possible, individuals at high risk for lung cancer should be strongly encouraged to participate in lung cancer screening trials or protocol-controlled observational studies.

• Diagnostic tests for lung cancer have traditionally been recommended only when overt symptoms of the disease have developed. Symptomatic lung cancer is usually at an advanced stage and almost always fatal.

• Surgical resection of early-stage lung cancer offers better potential for a good outcome. “For example, cure rates are 69% when the tumor size is less than 1.5 cm compared to 43% when the tumor size is greater than 4.5 cm,” the statement points out.

• Based on the evidence accumulated over the past five years, chest radiography or CT is a reasonable option for lung cancer screening. Annual screening with chest radiography should be recommended when CT is unavailable or unaffordable.

Notably, while CT appears to be more effective for detecting smaller cancers, it is also much more likely to detect benign nodules that precipitate further testing. This testing may include lung biopsy, which carries a significant risk of complications.

—Timothy Begany

Reference
1. Strauss GM, Dominioni L, Jett JR, et al. Como International Conference position statement: Lung cancer screening for early diagnosis 5 years after the 1998 Varese conference. Chest. 2005;127:1146-1151.

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