April 15, 2024

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USPSTF: 2021 Low-dose Spiral CT Screening Guidelines for Lung Cancer

USPSTF: 2021 Low-dose Spiral CT Screening Guidelines for Lung Cancer



USPSTF: 2021 Low-dose Spiral CT Screening Guidelines for Lung Cancer.   


The new guidelines for lung cancer screening in the United States are released, and the number of people recommended to be screened has almost doubled!


Lung cancer ranks first in the global mortality rate, and its cause is inseparable from lifestyle. Early screening is conducive to timely detection.  According to the latest data from the World Health Organization, lung cancer is still the world’s number one cause of death from cancer. 


In fact, the cure rate of early lung cancer is very high, but there are often no special symptoms in the early stage, and the diagnosis is often in the advanced stage. Through lung cancer screening, we can kill cancer in the cradle in time and increase the cure rate.


Low-dose spiral CT is recognized as the first choice for lung cancer screening. However, different guidelines still have different opinions on who needs to be screened.


The United States Preventive Services Task Force (USPSTF) issued the “2021 Lung Cancer Low-dose Spiral CT Screening Guidelines.” According to the new guidelines, the number of people recommended to undergo lung cancer screening has nearly doubled! Let’s take a look at what the new guidelines say:


USPSTF recommends:

50-80 years old, ≥20 years of smoking history, smokers or those who quit smoking within 15 years should undergo low-dose spiral CT screening every year.

If you have quit smoking for more than 15 years, or if you find a major illness or a health problem that requires radical lung surgery, you should stop the screening.

The new guidelines lower the minimum screening age from 55 to 50 years, and lower the minimum smoking age from 30 years to 20 years.




01. Women should increase the screening rate

Experts predict that the new guidelines reduce the screening age and “pack-year smoking history” (ie, the number of cigarettes smoked per day × the number of years of smoking, used to measure the degree of tobacco exposure), and will help improve lung cancer screening in two key populations Rate: women and blacks.


“Women and blacks are two people who are more likely to develop lung cancer after less exposure to tobacco,” said Dr. Mara Antonov, an expert in thoracic surgery at MD Anderson Cancer Center. “The new lung cancer screening guidelines will help Increasing the rate of early diagnosis of lung cancer among such high-risk groups.”


In recent years, some studies have found that higher levels of estrogen in women may promote the occurrence of lung cancer. This means that women are more sensitive to carcinogens in tobacco, and under the same circumstances, women are more likely to develop lung cancer than men.


In recent years, the smoking rate among Chinese women has increased. Therefore, this proposal also has certain practical significance to us.




02. Lung cancer screening must be persisted every year

The new guidelines recommend that those eligible should be screened annually. However, according to the old guidelines, only 14% of people with a history of smoking who met the screening criteria were screened for lung cancer.


Dr. Robert Walker, a cancer prevention expert at MD Anderson Cancer Center, pointed out that lung cancer screening does not happen overnight.


A clinical study led by Dr. Walker found that only 55% of people who were screened for lung cancer followed the new annual screening recommendations. Those smokers, ethnic minorities, and low-educated people have a lower proportion of promptly following the new guidelines for lung cancer screening.




03. Quitting smoking is still the most effective way to reduce the risk of lung cancer

The vast majority of lung cancer cases can be attributed to smoking.


Although lung cancer screening is crucial in reducing lung cancer mortality, the most critical means to prevent lung cancer is to quit smoking/not smoking (including other tobacco products).


“Although the smoking rate in the United States continues to decline, it is a pity that smoking is still the most important factor leading to the occurrence and death of lung cancer,” said Dr. Ernest Hawke, MD Anderson’s clinical cancer prevention expert.


In China, the situation is even more severe. According to China’s “Global Adult Tobacco Survey”, the current adult smoking rate in some countries is about 26.6% (about 50.5% for men and 2.1% for women). Among them, only 16.1% of smokers plan or are considering quitting in the next 12 months.




04. Is it not recommended to be screened if there is no history of smoking?

Although smoking is the main cause of most lung cancers, there are still 20% of lung cancer patients who have never smoked. The new guidelines do not recommend lung cancer screening.


In this regard, Dr. Walker explained that the reason why only smokers are recommended to be screened is because there are certain risks in the screening process. “Because in these low-risk non-smokers, CT screening may do more harm than good.”


On the other hand, the hazards of kitchen fume cannot be ignored. Kitchen oil fume contains more than 200 harmful substances, including many carcinogens. “Lung Cancer” magazine published a related study: cooking oil fume can increase the risk of lung cancer in non-smokers by 3.79 times.


Therefore, even if you do not smoke, if you are over 50 years old, there are people around you who smoke, have a history of radon exposure or occupational exposure, have a family history of lung cancer (especially a first-degree relative), have a history of chronic obstructive pulmonary disease or pulmonary fibrosis Wait, it is also recommended to do lung cancer screening once a year.


In addition, the guidelines also recommend that patients consult their doctors before screening to fully understand the potential pros and cons of screening.


Regardless of whether you have a history of smoking, if you have the following symptoms, it is recommended to seek immediate medical attention: persistent cough, pneumonia (unhealed for a long time), abnormal weight loss or voice changes. It is not the best for lung cancer. The key is to be responsible for yourself. If you find a serious health problem, you can treat it in time.


Finally, some smokers think that since people who don’t smoke can also get lung cancer, I don’t have to quit smoking. Wrong!


Because the genetic mutations of lung cancer in smokers and non-smokers are completely different, non-smokers usually carry EGFR and ALK mutations, and the proportion of non-smokers in Asian women with lung cancer is even close to 50%.


The EGFR and ALK gene mutations are “golden mutations”, and many targeted drugs have been marketed; while smoking patients have fewer treatment options. Therefore, the survival rate and quality of life of lung cancer patients who also have lung cancer and non-smokers are likely to exceed those of smokers.



(source:internet, reference only)

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