Skip to Main Content

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Population

  • Adults, asymptomatic.

Recommendation

USPSTF 2016

  • Do not screen asymptomatic adults for COPD.

Source

  • JAMA. 2016;315(13):1372-1377.

Comments

  1. Detection while asymptomatic doesn’t alter disease course or improve outcomes.

  2. Several symptom-based questionnaires have high sensitivity for COPD.

  3. In symptomatic patients (ie, dyspnea, chronic cough, or sputum production with a history of exposure to cigarette smoke or other toxic fumes), diagnostic spirometry to measure FEV1/FVC ratio is indicated.

LUNG CANCER

Population

  • Asymptomatic persons with smoking history.

Recommendations

USPSTF 2013, ACCP 2018, NCCN 2019

  • Screen for lung cancer annually with low-dose chest CT in older adults who have at least a 30 pack-year smoking history.

    • USPSTF: age 55–80 y.

    • ACCP: age 55–77 y.

    • NCCN: 55–74 y, or age ≥50 with ≥20 pack-year smoking history and other cancer risk factors.a

  • Stop screening if a person has not smoked for 15 y, or if they develop a significant medical problem that would limit ability to receive treatment for an early stage lung cancer.

  • Do not screen routinely with chest x-ray and/or sputum cytology.

  • Only screen if a highly skilled support team is available to evaluate CT scans, schedule appropriate follow-up, and perform lung biopsies safely when indicated.

Sources

Comments

  1. Less than 1 in 1000 patients with a false-positive result experience a major complication resulting from diagnostic workup.

    1. Counsel all patients against tobacco use, no matter their age. Smokers who quit gain ∼10 y of increased life expectancy and have maximum reduction in risk of lung cancer after 15 y of no tobacco use. (Br Med J. 2004:328)

    2. Spiral CT screening can detect greater number of lung cancers in smokers with a >10-pack-year exposure. (N Engl J Med. 2006;355:1763-1771)

    3. The NCI has reported data from the National Lung Screening Trial (NLST), a randomized controlled trial comparing LDCT and CXR yearly × 3 with 8-y follow-up. A total of 53,500 men and women age 50–74 y, 30 pack-year smokers were randomized. A 20.3% reduction in deaths from lung cancer was reported for the LDCT group (estimated that 10,000–15,000 lives could be saved per year). Problems with false-positives (25% have lung nodules <1 cm that are not cancer) and cost of workup were noted, but benefits have led to a change in guidelines.

    4. The ACCP, ACS, NCCN, and ASCO formally recommend LDCT screening for patients who meet the criteria of the NLST study. (It is estimated that 8.6 million Americans meet NLST criteria for screening, ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.