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Lung cancer screening (LCS) with low-dose CT (LDCT) imaging was recommended in 2013, making approximately 8 million Americans eligible for LCS. The demographic characteristics and outcomes of individuals screened in the United States have not been reported at the population level. What are the outcomes among people screened and entered in the American College of Radiology's Lung Cancer Screening Registry compared with those of trial participants? This was a cohort study of individuals undergoing baseline LDCT imaging for LCS between 2015 and 2019. Predictors of adherence to annual screening were computed. LDCT scan interpretations by Lung Imaging Reporting and Data System (Lung-RADS) score, cancer detection rates (CDRs), and stage at diagnosis were compared with National Lung Cancer Screening Trial data. Adherence was 22.3%, and predictors of poor adherence included current smoking status and Hispanic or Black race. On baseline screening, 83% of patients showed negative results and 17% showed positive screening results. The overall CDR was 0.56%. The percentage of people with cancer detected at baseline was higher in the positive Lung-RADS categories at 0.4% for Lung-RADS category 3, 2.6% for Lung-RADS category 4A, 11.1% for Lung-RADS category 4B, and 19.9% for Lung-RADS category 4X. The cancer stage distribution was similar to that observed in the National Lung Cancer Screening Trial, with 53.5% of patients receiving a diagnosis of stage I cancer and 14.3% with stage IV cancer. Underreporting into the registry may have occurred. This study revealed both the positive aspects of CT scan screening for lung cancer and the challenges that remain. Findings on CT imaging were correlated accurately with lung cancer detection using the Lung-RADS system. A significant stage shift toward early-stage lung cancer was present. Adherence to LCS was poor and likely contributes to the lower than expected cancer detection rate, all of which will impact the outcomes of patients undergoing screening for lung cancer. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Pharmacotherapies remain a central focus of successful tobacco control, but uptake remains very low. Objective: To estimate the cost effectiveness of a primary care nicotine replacement therapy (NRT) sampling intervention. Design: A Markov cohort simulation model was constructed to conduct cost-effectiveness analyses. Clinical trial results were used to initialize the Markov model. All other model parameters were derived from the literature. The study was conducted over a lifetime horizon, from the payers' budgetary perspective. Participants: Smokers with a primary care visit. Intervention: Medication sampling, which provided short, starter packets of NRT (nicotine patch and lozenge) to smokers in the primary care setting. Main Measures: Lifetime healthcare expenditures, quality-adjusted life years, and life years. Key Results: Medication sampling was the dominant strategy compared to standard care. Our intervention cost $75, yielding a discounted lifetime savings of $1065 in healthcare expenditures, and increased both discounted quality-adjusted life years and discounted life years by 0.01. One-way sensitivity analyses showed that medication sampling remained dominant in plausible ranges except when it failed to increase cessation relative to standard care. Probabilistic sensitivity analyses confirmed that medication sampling was dominant in 94.1% of the simulated cases, with an implementation cost of $74 (95% CI $73–$76) and discounted lifetime savings in health expenditures of $1061 (− $1106 to − $1,017), increasing quality-adjusted life years by 0.008 (0.0085–0.0093) and life years by 0.008 (0.0081–0.0089). Conclusion: Medication sampling, an easily implementable, scalable and low-cost intervention to encourage smoking cessation, is cost saving and improves quality of life. [ABSTRACT FROM AUTHOR]

Background: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was recommended by the U.S. Preventive Services Task Force (USPSTF) in 2013, making approximately 8 million Americans eligible for screening. The demographic characteristics and adherence of persons screened in the United States have not been reported at the population level.Objective: To define sociodemographic characteristics and adherence among persons screened and entered into the American College of Radiology's Lung Cancer Screening Registry (LCSR).Design: Cohort study.Setting: United States, 2015 to 2019.Participants: Persons receiving a baseline LDCT for LCS from 3625 facilities reporting to the LCSR.Measurements: Age, sex, and smoking status distributions (percentages) were computed among persons who were screened and among respondents in the 2015 National Health Interview Survey (NHIS) who were eligible for screening. The prevalence between the LCSR and the NHIS was compared with prevalence ratios (PRs) and 95% CIs. Adherence to annual screening was defined as having a follow-up test within 11 to 15 months of an initial LDCT.Results: Among 1 159 092 persons who were screened, 90.8% (n = 1 052 591) met the USPSTF eligibility criteria. Compared with adults from the NHIS who met the criteria (n = 1257), screening recipients in the LCSR were older (34.7% vs. 44.8% were aged 65 to 74 years; PR, 1.29 [95% CI, 1.20 to 1.39]), more likely to be female (41.8% vs. 48.1%; PR, 1.15 [CI, 1.08 to 1.23]), and more likely to currently smoke (52.3% vs. 61.4%; PR, 1.17 [CI, 1.11 to 1.23]). Only 22.3% had a repeated annual LDCT. If follow-up was extended to 24 months and more than 24 months, 34.3% and 40.3% were adherent, respectively.Limitations: Underreporting of LCS and missing data may skew demographic characteristics of persons reported to be screened. Underreporting of adherence may result in underestimates of follow-up.Conclusion: Approximately 91% of persons who had LCS met USPSTF eligibility criteria. In addition to continuing to target all eligible adults, men, those who formerly smoked, and younger eligible patients may be less likely to be screened. Adherence to annual follow-up screening was poor, potentially limiting screening effectiveness.Primary Funding Source: None. [ABSTRACT FROM AUTHOR]

Background: Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not.Methods: Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development and Evaluation approach. Meta-analyses were performed where appropriate. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached.Results: The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements.Conclusions: Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance. [ABSTRACT FROM AUTHOR]

Background: Low-dose chest CT screening for lung cancer has become a standard of care in the United States, in large part because of the results of the National Lung Screening Trial (NLST). Additional evidence supporting the net benefit of low-dose chest CT screening for lung cancer, and increased experience in minimizing the potential harms, has accumulated since the prior iteration of these guidelines. Here, we update the evidence base for the benefit, harms, and implementation of low-dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not.Methods: Approved panelists reviewed previously developed key questions using the Population, Intervention, Comparator, Outcome format to address the benefit and harms of low-dose CT screening, and key areas of program implementation. A systematic literature review was conducted using MEDLINE via PubMed, Embase, and the Cochrane Library on a quarterly basis since the time of the previous guideline publication. Reference lists from relevant retrievals were searched, and additional papers were added. Retrieved references were reviewed for relevance by two panel members. The quality of the evidence was assessed for each critical or important outcome of interest using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Meta-analyses were performed when enough evidence was available. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached.Results: The systematic literature review identified 75 additional studies that informed the response to the 12 key questions that were developed. Additional clinical questions were addressed resulting in seven graded recommendations and nine ungraded consensus statements.Conclusions: Evidence suggests that low-dose CT screening for lung cancer can result in a favorable balance of benefit and harms. The selection of screen-eligible individuals, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can impact this balance. [ABSTRACT FROM AUTHOR]

Proposals for expanding Medicare insurance coverage to uninsured Americans approaching the Medicare eligibility age of sixty-five has been the subject of intense debate. We undertook this study to assess cancer survival differences between uninsured patients younger than age sixty-five and older Medicare beneficiaries by using data from the National Cancer Database from the period 2004-16. The main outcomes were survival at one, two, and five years for sixteen cancer types in 1,206,821 patients. We found that uninsured patients ages 60-64 were nearly twice as likely to present with late-stage disease and were significantly less likely to receive surgery, chemotherapy, or radiotherapy than Medicare beneficiaries ages 66-69, despite lower comorbidity among younger patients. Compared with older Medicare patients, younger uninsured patients had strikingly lower five-year survival across cancer types. For instance, five-year survival in younger uninsured patients with late-stage breast or prostate cancer was 5-17 percent lower than that among older Medicare patients. We conclude that survival after a diagnosis of cancer is considerably lower in younger uninsured patients than in older Medicare patients. Expanding comprehensive health insurance coverage to people approaching Medicare age eligibility may improve cancer outcomes in the US. [ABSTRACT FROM AUTHOR]

Background: Bronchoscopy is commonly used to evaluate suspicious lung lesions. The yield is likely dependent on patient, radiographic, and bronchoscopic factors. Few studies have assessed these factors simultaneously while also including the preprocedure physician-assessed probability of cancer (pCA) when assessing yield.Methods: This study is a secondary data analysis from a prospective multicenter trial. Diagnostic yield of standard bronchoscopy with biopsy ± fluoroscopy, endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA), electromagnetic navigation, and combination bronchoscopies was assessed. Definitions for diagnostic and nondiagnostic bronchoscopies were rigorously predefined. The association of diagnostic yield with individual variables was examined by using univariate and multivariate logistic regression analyses where appropriate.Results: A total of 687 patients were included from 28 sites. Overall diagnostic yield was 69%; 80% for EBUS, 55% for bronchoscopy with biopsy ± fluoroscopy, 57% for electromagnetic navigation, and 74% for combination procedures (P < .001). Patients with larger, central lesions with adenopathy were significantly more likely to undergo a diagnostic bronchoscopy. Patients with pCA < 10% and 10% to 60% had lower yields (44% and 42%, respectively), whereas pCA > 60% yielded a positive result in 77% (P < .001). In multivariate logistic regression, the use of EBUS-TBNA, larger sized lesions, and central location were significantly associated with a diagnostic bronchoscopy. Seventeen percent of those with a malignant diagnosis and 28% of those with a benign diagnosis required secondary procedures to establish a diagnosis.Conclusions: This study is the first to assess the yield of bronchoscopy according to physician-assessed pCA in a large, prospective multicenter trial. The yield of bronchoscopy varied greatly according to physician suspicion that cancer is present, the patients' clinical/radiographic features, and the type of procedure performed. Of the procedures performed, EBUS-TBNA was the most likely to provide a diagnosis. [ABSTRACT FROM AUTHOR]

Background: Shared decision-making is an essential element of low-dose CT (LDCT) screening for lung cancer. Understanding patient-level outcomes from the National Lung Screening Trial (NLST) is critical to effectively communicate risks and benefits of screening to patients.Methods: We performed a secondary analysis of data collected in the NLST. We determined outcomes of each LDCT scan performed in the NLST (downstream evaluation, complications, lung cancer diagnoses), and compared outcomes at the test level with outcomes calculated at the patient level for those randomized to LDCT screening. To assess the impact of COPD on patient outcomes, we compared outcomes among patients with and without COPD.Results: Of 75,138 LDCT scans, 14.2% led to a diagnostic study and 1.5% to an invasive procedure, with 0.3% of LDCT scans resulting in a procedure-related complication and 0.1% in a serious complication. Among 24,453 patients who underwent LDCT screening, 30.5% underwent a diagnostic study and 4.2% an invasive procedure, with 0.9% of screened patients experiencing a procedure-related complication and 0.3% a serious complication. Patients with COPD (defined by self-report) were more likely to need a diagnostic study (adjusted OR [aOR], 1.29; P < .01) and an invasive procedure (aOR, 1.41; P < .01) and more likely to experience a complication (aOR, 1.83; P < .01) and a serious complication (aOR, 1.78; P = .01). Patients with COPD also were more likely to be diagnosed with lung cancer (aOR, 1.43; P < .01).Conclusions: We provide important patient-level data from the NLST that can be used to guide shared decision-making. The risk-to-benefit ratio of screening may vary significantly in some patients, such as those with COPD, in whom both risks and benefits of screening may be increased. [ABSTRACT FROM AUTHOR]

Screening with low-dose CT scan has been shown to reduce mortality from lung cancer in those at risk based on age and smoking history. While lung cancer screening (LCS) is recommended by the United States Preventative Services Task Force and many professional societies, it has been recognized that the decision to be screened is complex due to a close balance of risk and benefit; therefore, shared decision-making is considered an essential component of effective LCS. The Centers for Medicare and Medicaid Services provides coverage for LCS following a mandated shared-decision making (SDM) visit. Here we review the concept of SDM, facilitators and barriers, evidence and knowledge gaps, and novel considerations for SDM within LCS. [ABSTRACT FROM AUTHOR]

Background: Lung nodules are a diagnostic challenge, with an estimated yearly incidence of 1.6 million in the United States. This study evaluated the accuracy of an integrated proteomic classifier in identifying benign nodules in patients with a pretest probability of cancer (pCA) ≤ 50%.Methods: A prospective, multicenter observational trial of 685 patients with 8- to 30-mm lung nodules was conducted. Multiple reaction monitoring mass spectrometry was used to measure the relative abundance of two plasma proteins, LG3BP and C163A. Results were integrated with a clinical risk prediction model to identify likely benign nodules. Sensitivity, specificity, and negative predictive value were calculated. Estimates of potential changes in invasive testing had the integrated classifier results been available and acted on were made.Results: A subgroup of 178 patients with a clinician-assessed pCA ≤ 50% had a 16% prevalence of lung cancer. The integrated classifier demonstrated a sensitivity of 97% (CI, 82-100), a specificity of 44% (CI, 36-52), and a negative predictive value of 98% (CI, 92-100) in distinguishing benign from malignant nodules. The classifier performed better than PET, validated lung nodule risk models, and physician cancer probability estimates (P < .001). If the integrated classifier results were used to direct care, 40% fewer procedures would be performed on benign nodules, and 3% of malignant nodules would be misclassified.Conclusions: When used in patients with lung nodules with a pCA ≤ 50%, the integrated classifier accurately identifies benign lung nodules with good performance characteristics. If used in clinical practice, invasive procedures could be reduced by diverting benign nodules to surveillance.Trial Registry: ClinicalTrials.gov; No.: NCT01752114; URL: www.clinicaltrials.gov). [ABSTRACT FROM AUTHOR]

Background: Low-dose chest CT screening for lung cancer has become a standard of care in the United States in the past few years, in large part due to the results of the National Lung Screening Trial. The benefit and harms of low-dose chest CT screening differ in both frequency and magnitude. The translation of a favorable balance of benefit and harms into practice can be difficult. Here, we update the evidence base for the benefit, harms, and implementation of low radiation dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not.Methods: Approved panelists developed key questions using the PICO (population, intervention, comparator, and outcome) format to address the benefit and harms of low-dose CT screening, as well as key areas of program implementation. A systematic literature review was conducted by using MEDLINE via PubMed, Embase, and the Cochrane Library. Reference lists from relevant retrievals were searched, and additional papers were added. The quality of the evidence was assessed for each critical or important outcome of interest using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Important clinical questions were addressed based on the evidence developed from the systematic literature review. Graded recommendations and ungraded statements were drafted, voted on, and revised until consensus was reached.Results: The systematic literature review identified 59 studies that informed the response to the 12 PICO questions that were developed. Key clinical questions were addressed resulting in six graded recommendations and nine ungraded consensus based statements.Conclusions: Evidence suggests that low-dose CT screening for lung cancer results in a favorable but tenuous balance of benefit and harms. The selection of screen-eligible patients, the quality of imaging and image interpretation, the management of screen-detected findings, and the effectiveness of smoking cessation interventions can affect this balance. Additional research is needed to optimize the approach to low-dose CT screening. [ABSTRACT FROM AUTHOR]

Lung cancer patients are at high risk of suffering due to severe and refractory symptoms, concomitant respiratory comorbidity, frequent disease progression, and treatment that can worsen and compromise quality of life. Palliative care (PC) has shown multiple benefits to cancer patients such as better quality of life, higher patient and family satisfaction, improved disease understanding, less symptom burden, fewer depressive symptoms, less aggressive end of life care, and even improved survival with early implementation. For these reasons, multiple societies have recognized PC as an essential component of lung cancer care, and early PC is recommended for patients with metastatic disease or refractory symptoms. Unfortunately, utilization of PC is both low and often near the end of life, increasing risk for suffering. Misconceptions about PC often underlie delayed referral to PC. This review summarizes the literature for utilization of PC in lung cancer and focuses on patient benefits, misconceptions, barriers, and implementation. [ABSTRACT FROM AUTHOR]

An editorial is presented on smoking trends and lung cancer mortality in the U.S. It explores various studies which examined the effects of smoking on health. The said studies predicted that 4.4 million Americans will die of lung cancer in the next half-century and countless more will die of other tobacco-related cancer and cardiovascular disease.

Although the revised (2021) US Preventive Services Task Force recommendations for lung cancer screening offer the opportunity to save more lives and reduce disparities, National Lung Cancer Roundtable members share a cautionary message about the challenges ahead. To facilitate high‐quality care for diverse populations, a patient‐centered approach is needed that incorporates high‐quality shared decision‐making, improved access to care and navigation, and more streamlined systems of care. [ABSTRACT FROM AUTHOR]

Lung cancer is the leading cause of cancer-related death in the United States. Since publication of results from the National Lung Screening Trial, several professional organizations, including the US Preventive Services Task Force, have published guidelines recommending low-dose computed tomography for screening in asymptomatic, high-risk individuals. The benefits of screening include detection of cancer at an early stage when a definitive cure is possible, but the risks include overdiagnosis, false-positive results, psychological distress, and radiation exposure. The current review covers the scope of low-dose computed tomography screening, potential risks, costs, and future directions in the efforts for early detection of lung cancer. Cancer 2015;121:1347-1356. © 2015 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: The current approaches for tissue diagnosis of a solitary pulmonary nodule are transthoracic needle aspiration, guided bronchoscopy, or surgical resection. The choice of procedure is driven by patient and radiographic factors, risks, and benefits. We describe a new approach to the diagnosis of a solitary pulmonary nodule, namely bronchoscopic transparenchymal nodule access (BTPNA).Methods: In anesthetized dogs, fiducial markers were placed and thoracic CT images acquired. From the CT scan, the BTPNA software provided automatic point-of-entry prescribing of a bronchoscopic path (tunnel) through parenchymal tissue directly to the lesion. The preplanned procedure was uploaded to a virtual bronchoscopic navigation system. Bronchoscopic access was performed through the tunnels created. Proximity of the distal end of the tunnel sheath to the target was measured, and safety was recorded.Results: In four canines, 13 tunnels were created. The average length of the tunnels was 32.3 mm (range, 24.7-46.7 mm). The average proximity measure was 5.7 mm (range, 0.1-12.9 mm). The distance from the pleura to the nearest point within the target was 7.4 mm (range, 0.1-15 mm). Estimated blood loss was <2 mL per case. There were no pneumothoraces.Conclusions: We describe a new approach to accessing lesions in the lung parenchyma. BTPNA allows bronchoscopic creation of a direct path with a sheath placed in proximity to the target, creating the potential to deliver biopsy tools within a lesion to acquire tissue. The technology appears safe. Further experiments are needed to assess the diagnostic yield of this procedure in animals and, if promising, to assess this technology in humans. [ABSTRACT FROM AUTHOR]

The article presents a study which describes an approach in accessing lesions in the lung parenchyma of canines. The safety and feasibility of bronchoscopic transparenchymal nodule access (BTPNA) are evaluated. The authors recommend further studies on the accuracy of BTPNA in the diagnosis of solitary pulmonary nodule.

The article discusses the developments in advanced diagnostic and therapeutic pulmonary procedures. One new technology is navigational bronchoscopy (NB), which was developed to enhance the diagnostic yield of traditional white-light bronchoscopy. The evolution of endobronchial ultrasound (EBUS) to cover the diagnosis, imaging, staging and treatment of thoracic malignancies is tackled. Other topics include bronchoscopic lung volume reduction, bronchial thermoplasty and pleural procedures.

The article discusses the outcomes and effectiveness of the low-dose computed tomography (LDCT) and chest radiography that was suggested to the heavy smokers for detection of lung cancer in the National Lung Screening Trial (NLST), a research study sponsored by the U.S. National Cancer Institute. It questions the reliability and authenticity of the methods adopted for diagnosis of cancer. It informs that NLST found that diagnosis of lung cancer at early stages might prove beneficial.

The article features research of Momen M. Wahidi and team on competency metrics and educational intervention on the bronchoscopy skills in pulmonary physicians in the U.S. Researchers did a prospective study on how to assess the level of doctors' bronchoscopy skills using various methods. They found that performance competency metrics is an effective tool to evaluate the said ability, while educational interventions can accelerate the skills of first-year pulmonary fellows.

In this article, the author discusses the importance of the Master Settlement Agreement (MSA) and its impact on tobacco use. The author states that the MSA had on tobacco control locally and nationally and it reduces smoking in particular state. The author infers that the policy is formulated so that physicians and other health-care advocacy groups could understand the present-day political dynamics and be more effective in shaping tobacco control in the future.

The author reflects on the application of cryobiopsies in transbronchial lung biopsies. Topics discussed include the comparison of the approach with the traditional transbronchial lung biopsy (TBLB), citing the poor outcome of the TBLB procedure due to the size of lung tissue, the risk of mortality associated with surgical lung biopsies, and the emergence of the cryo-transbronchial biopsy (cryo-TBB) as alternative to TBLB.

The article focuses on the epidemiology and screening of lung cancer. Lung cancer is said to be the 10th leading cause of death globally, but it is expected to move to a higher place as its prevalence increases in developing countries. Active cigarette smoking is considered as the main cause of lung cancers. Other causes include secondhand cigarette smoke, pipe smoking, occupational exposure and air pollution. The relevance of screening to reduce mortality from lung cancer is explained, along with an overview of studies related to lung cancer screening. The efficacy of low radiation dose computed tomography in detecting early lung cancer in asymptomatic patients is also noted.

The article focuses on the randomized, double-blind study in assessing the efficacy and safety of fospropofol disordium injection for moderate sedation in patients under flexible bronchoscopy in the U.S. Study shows that most frequent adverse events (AEs) were transient and self-limited paresthesias and pruritus of mild-to-moderate severity. It was found out that fosprofol provide safe and effective sedation for these patients.

The article presents insights on whether surgery have a place in the treatment of patients with stage IIIa (N2) non-small cell lung cancer (NSCLC). Topics covered include the conclusion that chemoradiotherapy is the standard of care for patients with N2 disease, the lack of evidence for surgery after induction therapy in Pancoast tumors with N2 disease and the use of multimodality therapy in superior sulcus tumors (SST).

The article discusses the noninvasive staging of non-small cell lung cancer. It has been noted that correctly staging lung cancer is vital because the treatment options and the prognosis differ significantly by stage. Various imaging studies including chest computed tomography (CT) scanning and positron emission tomography (PET) scanning are available. Understanding the test characteristics of these noninvasive staging studies is crucial to decision making.

The article presents a study which evaluates the evidence for, and against screening for lung cancer with low-dose computed tomography. Results reveal that studies of lung cancer screening with chest radiograph and sputum cytology have failed to demonstrate that screening lowers lung cancer mortality rates. Such findings allow researchers to recommend that individuals undergo screening only when it is administered as a component of a well-designed clinical trial.

Background: There has been resurgence of interest in lung cancer screening using low-dose computed tomography. The implications of directing a screening programme at smokers has been little explored. Methods: A nationwide telephone survey was conducted. Demographics, certain clinical characteristics and attitudes about screening for lung cancer were ascertained. Responses of current, former and never smokers were compared. Results: 2001 people from the US were interviewed. Smokers were significantly (p<0.05) more likely than never smokers to be male, non-white, less educated, and to report poor health status or having had cancer, and less likely to be able to identify a usual source of healthcare. Compared with never smokers, current smokers were less likely to believe that early detection would result in a good chance of survival (p<0.05). Smokers were less likely to be willing to consider computed tomography screening for lung cancer (71 .2% (current smokers) v 87.6% (never smokers) odds ratio (OR) 0.48; 95% confidence interval (CI) 0.32 to 0.71). More never smokers as opposed to current smokers believed that the risk of disease (88% v 56%) and the accuracy of the test (92% v 71%) were important determinants in deciding whether to be screened (p<0.05). Only half of the current smokers would opt for surgery for a screen-diagnosed cancer. Conclusion: The findings suggest that there may be substantial obstacles to the successful implementation of a mass-screening programme for lung cancer that will target cigarette smokers. [ABSTRACT FROM AUTHOR]

The article presents information on the therapeutic treatment of non-small cell lung cancer (NSCLC). After prostate cancer among men and breast cancer among women, lung cancer is the most common cause of cancer death. Currently followed first-line treatment for patients with advanced NSCLC includes chemotherapy and palliative radiotherapy. It has been identified that mutation of the epidermal growth factor receptor (EGFR) takes place in the NSCLC cells. A common feature of many cancers is the overexpression of the EGFR and its ligands. So various antitumor strategies find EGFR as an attractive target.

Provides guidelines on interventional pulmonary procedures from the American College of Chest Physicians. Flexible bronchoscopy; Rigid bronchoscopy; Pediatric section; Transbronchial needle aspiration; Transtracheal oxygen therapy.

Correctly staging lung cancer is extremely important because the treatment options and the prognosis differ significantly by stage. Several noninvasive imaging studies are available to aid in identifying disease both within and outside of the chest. Chest CT scanning is useful in providing anatomic detail that better identifies the location of the tumor, its proximity to local structures, and whether or not lymph nodes in the mediastinum are enlarged. Unfortunately, the accuracy of chest CT scanning in differentiating benign from malignant lymph nodes in the mediastinum is unacceptably low. Whole-body positron emission tomography (PET) scanning provides functional information on tissue activity and has much better sensitivity and specificity than chest CT scanning for staging lung cancer in the mediastinum. In addition, metastatic disease can be detected by PET scan. Still, positive findings of PET scans can occur from nonmalignant etiologies (eg, infections), so that tissue sampling to confirm the suspected malignancy must be performed. The clinical evaluation tool, which is composed of a thorough history and physical examination, remains the best predictor of metastatic disease. If the findings from the clinical evaluation are negative, then imaging studies such as a CT scan of the head, a bone scan, or an abdominal CT scan are unnecessary, and the search for metastatic disease is complete. If signs, symptoms, or findings from the physical examination suggest the presence of malignancy, then sequential imaging, starting with the most appropriate study based on the clues obtained by the clinical evaluation, should be performed. Abnormalities detected by all of the aforementioned imaging studies are not always cancer. Unless overwhelming evidence of metastatic disease is present on an imaging study, in situations in which it will make a difference in treatment, all abnormal scan findings require tissue confirmation of malignancy so that patients are not... [ABSTRACT FROM AUTHOR]

Provides an overview of several radiation therapy used in palliative care for the dying patient with lung cancer. Definition of palliative care; Advancements in radiation therapy, chemotherapy and medications; Description of hospice benefit and the methods of integrating palliative techniques.

Presents a study to determine how patients with lung cancer value the trade off between the survival benefit of chemotherapy and its toxicities. Subjects; Methods; Results; Conclusion. INSET: Key messages.

The article discusses the results of a study, published within the issue, which examined the evidence-based clinical practice guidelines (CPG) that provide direction for physicians. The study showed that one in five patients with suspected lung cancer and adenopathy received guideline-consistent care. An overview of the 2007 American College of Chest Physicians (ACCP) evidence-based CPS on lung cancer is given. Also discussed are the reasons why physicians do not follow published guidelines.

The author discusses improving physician-patient communication in order not to worsen patients' apprehensions regarding the discovery of a solitary pulmonary nodule that may or may not be cancer. He references the article "What Do You Mean, a Spot? A Qualitative Analysis of Patients' Reactions to Discussion With Their Doctors About Pulmonary Nodules" by R. S. Wiener and colleagues within the issue. He highlights patients' fears and provides practical advice to address them.

Editorial. Comments on an article studying the diagnostic procedures that may be used for staging lung cancer, published in the February 2003 issue of 'Chest.' Computed tomography; Positron emission tomography; Endoscopic ultrasound with fine-needle aspiration; Transbronchial needle aspiration; Thoracoscopy; Mediastinoscopy; Mediastinotomy.

The article presents a response to arguments in favor of adding surgery to standard-of-care chemoradiotherapy alone for treatment of patients with superior sulcus tumor (SST) and mediastinal (N2) lymphadenopathy. Topics covered include the reference made to studies in which trimodality therapy was used in patients with SSTs and N2 disease, the conduct of studies which confirm that N2 disease is an adverse prognostic factor and the call for surgery for SSTs with N2 involvement.