Guidelines for CT Use in Lung Cancer Screening

Guidelines for CT Use in Lung Cancer Screening

In August 2011, results of the National Lung Screening Trial (NLST) were published in the New England Journal of Medicine. The study found that low-dose CT (LDCT) screening correlated with a reduction in lung cancer-specific mortality of 20% when compared with radiography. In September 2011, the American Association of Thoracic Surgeons (AATS) launched a task force to interpret NLST and several similar European trials in order to establish guidelines on lung cancer screening. The resulting recommendations were recently published in the Journal of Thoracic and Cardiovascular Surgery. The AATS recommendations for use of LDCT in lung cancer screening were most heavily influenced by NLST. The study was specifically designed to answer whether LDCT could positively affect mortality risk for 30 pack-year smokers aged 55 to 74 with a baseline 10-year risk of 2% for developing lung cancer. The NLST also heavily influenced guidelines from other professional societies on LDCT screening. A Tiered Approach for Lung Screening The AATS guidelines use a three-tiered approach. In tier one, it recommends annual LDCT screening from age 55 to 79 for those with a 30 pack-year smoking history. The AATS recommends continuing screening to age 79 because: • The peak incidence of lung cancer in the United States is age 70. • The average life expectancy in the U.S. is 78.6 years. • Age alone is a risk factor for lung cancer. The AATS recommends that screening cease at age 79 because the advantages of early detection are unclear among those aged 80 or older.   Tier two includes yearly LDCT screening for patients as young as 50 with a 20 pack-year history of smoking and an...

Identifying Acute Aortic Dissection Patients

It has been estimated that 5,000 to 10,000 aortic dissections occur in patients each year in the United States, and nearly one-third of these individuals will die before hospital discharge. Despite recent advances in diagnostic tools and surgery, the tearing of the aorta can be challenging for even the most experienced cardiovascular specialists to diagnose. In 2010, the American Heart Association and American College of Cardiology released clinical guidelines—developed in collaboration with 10 professional societies—for the diagnosis and management of thoracic aortic disease, emphasizing high-risk clinical features that indicate the presence of acute aortic dissection (AAD). Validation of these risk markers had yet to occur until the results of a study by the University of Michigan Cardiovascular Center (UMCC) published in 2011 in Circulation, which suggested patients with certain characteristics were likely to be suffering from an aortic dissection. “Over the past 20 years, much progress has been made in various facets of thoracic aortic disease,” says Kim A. Eagle, MD, co-author of both the guidelines for thoracic aortic disease and the aforementioned UMCC study. “This includes a better understanding of the natural history of thoracic aortic disease and the potential genetic factors that may underlie some of the aortic problems of the thorax. There has also been an evolution of modern imaging techniques for more reliable and speedy diagnoses and follow-up. Furthermore, new strategies for both medical and interventional therapy have emerged.” (see also, Strategies for Managing Thoracic Aortic Disease With Surgery). When compared with coronary heart disease, hypertension, or heart failure, thoracic aortic diseases are rarer, and therefore, probably encountered by practitioners less frequently. “As a result,”...