Computed Tomography (CT) Scanning for Lung Cancer Screening
DESCRIPTION
Given the poor prognosis of lung cancer, there has been long-standing research interest in developing screening techniques for those at high risk. Previous studies of serial sputum samples or chest x-rays failed to demonstrate that these screening techniques improved health outcomes. More recently, there has been interest in CT scanning as a screening technique, using either spiral (also referred to as helical) or electron beam (also referred to as ultrafast). Compared to conventional CT scanning, these CT scans allow for the continuous acquisition of images, thus shortening the scan time and radiation exposure. A complete spiral or electron beam CT scan can be obtained within 20 seconds, or during one breath hold, in the majority of patients. The radiation exposure for this exam is greater than for that of a chest x-ray, but much less than for a conventional CT scan.
POLICY
Computed tomography scanning, using either spiral (i.e., helical) or electron beam (i.e., ultrafast), as a screening technique for lung cancer is considered investigational.
ADDITIONAL INFORMATION
There is a lack of controlled scientific studies documenting the safety and efficacy of computed tomography, using either spiral (i.e., helical) or electron beam (i.e., ultrafast) scanning for lung cancer screening. The literature does not determine if this technology will reduce lung cancer mortality rates.
SOURCES
Agency for Healthcare Research & Quality. (2004, May). Lung cancer screening with sputum cytologic examination, chest radiography, and computed tomography. Retrieved January 20, 2009 from http://www.ahrq.gov/clinic/3rduspstf/lungcancer/lungsum.htm.
Agency for Healthcare Research & Quality. (2004, May). Recommendation statement. Lung cancer screening. Retrieved January 20, 2009 from http://www.ahrq.gov/clinic/3rduspstf/lungcancer/lungcanrs.htm.
Agency for Healthcare Research & Quality. (2004, May). Systematic evidence review No. 31: Lung cancer screening: An update for the U.S. Preventive Services Task Force. Retrieved January 20, 2009 from http://www.ahrq.gov/downloads/pub/prevent/pdfser/lungcanser.pdf.
American Cancer Society. (2007, January). Chronological history of ACS recommendations on early detection of cancer. Retrieved January 20, 2009 from http://www.cancer.org/docroot/PED/content/PED_2_3X_Chronological_History_of_ACS_Recommendations_on_Early_Detection_of_Cancer.asp?sitearea=PED.
BlueCross BlueShield Association. Medical Policy Reference Manual. (3:2008). Screening for Lung Cancer Using CT Scanning or Chest Radiographs (6.01.30).Retrieved January 20, 2009 from BlueWeb.
Grann, V. R., & Neugut, A. I. (2003). Lung cancer screening at any price? JAMA, 289 (3), 357-358.
ECRI Institute. Health Technology Assessment Information Service. Target database. (2004, July). Helical computed tomography (CT) for lung cancer screening. Retrieved January 26, 2007 from ECRI Institute. (42 articles and/ or guidelines reviewed)
ECRI Institue. Health Technology Assessment Information Service. Windows on Medical Technology. (2002, April). Helical CT for Detection of Lung Cancer. Retrieved April 25, 2003 from ECRI Institute. (91 articles and/or guidelines reviewed)
Libby, D. M., Wu, N., Lee, I. J., Faroogi, A., Smith, J. P., Pasmantier, M. W., et al. (2006). CT screening for lung cancer: The value of short-term CT follow-up. Chest, 129 (4), 1039-1042. Abstract retrieved January 30, 2007 from PubMed database.
Mahadevia, P. J., Fleisher, L. A., Frick, K. D., Eng, J., Goodman, S. N. & Powe, N. R. (2003). Lung cancer screening with helical computed tomography in older adult smokers: A decision and cost-effectiveness analysis. JAMA, 289 (3), 313-322.
Mulshine, J. L., & Sullivan, D. C. (2005). The New England Journal of Medicine, 352 (26), 2714-2720.
National Guideline Clearinghouse. (2005, February). Management of patients with lung cancer. A national clinical guideline. Retrieved January 20, 2009 from http://www.guidelines.gov/summary/summary.aspx?doc_id=6615&nbr=004159&string=cancer+AND+management+AND+guideline .
Pastorino, U., Bellomi, M., Landoni, C., De Fiori, E., Arnaldi, P., Picchio, M., et al. (2003). Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results. Lancet, 362 (9384), 593-597.
Swensen, S. J., Jett, J. R., Hartman, T. E., Midthun, D. E., Sloan, J. A., Sykes, A. M., et al. (2003). Lung cancer screening with CT: Mayo Clinic experience. Radiology, 226 (3), 756-761.
ORIGINAL EFFECTIVE DATE: 10/1/2003
MOST RECENT REVIEW DATE: 3/12/2009
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