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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 2020

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

    • USPSTF: age 55–80 y.

    • ACCP: age 55–77 y.

    • NCCN: 55–77 y, or age ≥50 if there are additional cancer risk factors in addition to a ≥20 pack-year smoking history.

  • – NCCN recommends use of the Tammemagi lung cancer risk calculator when weighing risk factors other than smoking history, a score >1.3% 6-y risk is considered sufficient risk to pursue screening.

  • – 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. Risk assessment for lung cancer:

    1. Cigarette smoking (20-fold increased risk). Medication and counseling together are better than either alone to increase cessation rates.

    2. Second-hand smoke exposure, according to NCCN, is not a sufficient risk factor for lung cancer to warrant a screening recommendation with LDCT. It is a highly variable exposure risk. However, it should be considered in conjunction with other risk factors. The Tammemagi lung cancer risk calculator can be used to assess risk.

    3. Family history of lung cancer in first-degree relatives.

    4. Pulmonary disease history (COPD or pulmonary fibrosis).

    5. Documented radon gas exposure (can be measured in the home), severe air pollution. Air pollution increases risk of lung cancer by 40% with highest pollution exposure. (Am J Respir Crit Care Med. 2006;173:667)

    6. Occupational exposures (silica, asbestos, arsenic, nickel, chromium, coal smoke, soot, diesel fumes).

  2. If a ...

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