Lung cancer screening guidelines topic of CHEST 2018 debate

Nichole T. Tanner, MD, MSCR
Nichole T. Tanner, MD, MSCR

They won’t be throwing jabs, upper cuts, or hooks in this session, but there will be a battle of opinions during The Smackdown in San Antonio: Debating Heavyweight Topics in the 2018 CHEST Lung Cancer Screening Guidelines on Wednesday at 7:30 am in the convention center, room 213A.

Nichole T. Tanner, MD, MSCR, chair of the session, wants you to come away with a better understanding and knowledge of the new CHEST guidelines for lung cancer screening during this educational, thought-provoking, and entertaining session.

Daily News caught up with Dr. Tanner, associate professor of medicine and co-director of the Lung Cancer Screening Program in the division of pulmonary, critical care, allergy, and sleep medicine at Medical University of South Carolina, for a glimpse into the session.

What is the impetus for this session?

Since the publication of the National Lung Screening Trial, which demonstrated a mortality benefit to screening those at high-risk for lung cancer based on age and smoking history with low-dose CT scan (LDCT), there has been minimal uptake in the U.S. population eligible for screening. The reason for this is multifactorial, and in part, has to do with confusion on screening recommendations and reaching those at risk who would benefit from screening. The CHEST recently updated its guidelines for lung cancer screening, which is the impetus for this session—to both highlight the new guidelines and discuss areas of active research and question in a fun way.

What are the current requirements for lung cancer screening?

According to the CHEST guidelines, eligible patients should be ages 55-77 and current or former smokers who have quit within the past 15 years, with a 30-pack year smoking history who do not have symptoms of lung cancer and are well enough to undergo treatment for a screen-detected cancer.

Why is there controversy as to whom should be eligible for screening?

The first four recommendations in the CHEST lung cancer screening guidelines address patient eligibility and comorbid diseases, yet there is much that is still unknown about who might best benefit from screening and the impact of comorbid disease. The age criteria for screening varies among professional societies and other guidelines (National Comprehensive Cancer Network) recommend screening in those with a lesser smoking history with additional risk factors for lung cancer (e.g. first-degree relative with a history of lung cancer).

Why is this a critical session for attendees to join and what is the target audience?

This session is designed to examine the unknown that is currently outside the purview of the new lung cancer screening guidelines. Designed as a pro/con debate, this session will highlight the guidelines and then proceed to discuss the unknown and what may be in store for the future of lung cancer screening (LCS). The target audience includes cardiothoracic surgeons, physicians-in-training, general medicine physicians, physician assistants, pulmonary physicians, registered nurses, and respiratory therapists.

How does comorbidity have an impact on patient selection?

Patient selection for LCS is complicated because the main risk factor for developing lung cancer—smoking—is also associated with other diseases that have a high mortality (for example, cardiovascular disease, pulmonary disease, and stroke). As the risk for lung cancer increases, so does the risk of death from competing causes and the risk of harms related to the diagnostic evaluation and treatment of a screen-detected cancer.

What are the pros/cons for each of these topics, in your opinion?

Are we ready for risk-based screening?

Pro: This could potentially make screening more efficient by enriching the population being screened and minimizing the number of false positive results.

Con: A risk-based screening strategy has not been studied in a randomized manner.

Are we ready to offer screening with LDCT to individuals with multiple comorbidites?

Pro: Alternative treatment options outside of surgery, such as steriotactic body radiotherapy (SBRT), which where not readily available during the National Lung Screening Trial have good cancer control rates in those unable to undergo surgery due to comorbid conditions.

Con: Comorbid diseases increase risk of death from other causes such as heart disease and pulmonary disease such that these competing causes of death diminish mortality benefit from lung cancer screening.