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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 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. ...

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