IL, September 10, 2007) —New evidenced-based guidelines from the
American College of Chest Physicians (ACCP) recommend against the use of
low-dose computed tomography (LDCT) for the general screening of lung
cancer. Published as a supplement to the September issue of CHEST, the
peer-reviewed journal of the ACCP, the guidelines cite there is little
evidence to show lung cancer screening impacts mortality in patients,
including those who are considered at high risk for the disease. The
guidelines also recommend against the use of vitamin or mineral
supplements for the prevention of lung cancer, for these do little to
decrease the risk of lung cancer, while beta-carotene has been
associated with increased risk of lung cancer.
“Even in high risk populations,
currently available research data do not show that lung cancer screening
alters mortality outcomes,” said W. Michael Alberts, MD, FCCP, chair of
the ACCP lung cancer guidelines and Chief Medical Officer, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, FL. “We hope that
one day, we can find a useful and accurate tool for general lung cancer
screening, but, at this time, the evidence does not support the use of
In its second edition, Diagnosis and Management of Lung Cancer: ACCP
Evidence-Based Clinical Practice Guidelines (2nd Edition) provides 260
of the most comprehensive recommendations related to lung cancer
prevention, screening, diagnosis, staging, and medical and surgical
treatments. The guidelines also review complementary and integrative
therapy for the prevention and treatment of lung cancer.
Due to the lack of supporting evidence, the guidelines recommend against
the use of LDCT, chest radiographs, or single or serial sputum cytologic
evaluation for lung cancer screening in the general population,
including smokers or others at high risk, except in the context of a
well-designed clinical trial. “Population screening for lung cancer is
not recommended and may, ultimately, put the patient at risk for further
complications,” said Gene L. Colice, MD, FCCP, vice chair of the ACCP
lung cancer guidelines and Director, Pulmonary, Critical Care, and
Respiratory Services, Washington Hospital Center, Washington, DC.
“Nodules are commonly found during screening; however, to determine
whether they are cancerous requires additional testing, which is fairly
invasive and extensive. This may cause the patient needless risk, both
physically and psychologically.”
The guidelines also recommend against the preventive use of several of
the following common supplements and medications in at-risk patients or
those with a history of lung cancer:
Beta-carotene – The guidelines strongly recommend against the use of
beta-carotene supplements for primary, secondary, or tertiary
prevention, citing the higher incidence of lung cancer among those who
use the supplement.
Vitamin A – The guidelines strongly recommend against the use of
retinoids (vitamin A), including isotretinoin, for they have not been
shown to decrease the incidence of second tumors and could increase
mortality among current smokers.
Vitamin E – Vitamin E is not recommended for lung cancer prevention, as
studies show no difference in the incidence of lung cancer among those
taking vitamin E compared with those not taking it.
Aspirin – Although some literature suggests that aspirin may play a
protective role regarding cancer, the guidelines do not recommend
aspirin for the prevention of lung cancer, as studies show that aspirin
does not decrease the risk of lung cancer or death due to lung cancer.
For the first time, the ACCP lung cancer guidelines have included
recommendations on mind-body modalities as part of a multimodality
approach to reduce the
Anxiety, mood disturbances, and chronic pain
associated with lung cancer. Massage therapy is recommended for patients
who are experiencing
Anxiety or pain, while acupuncture is recommended
for patients experiencing fatigue, dyspnea, chemo-induced neuropathy, or
in cases where pain or nausea/vomiting is poorly controlled.
Electrostimulation wristbands are not recommended for managing
chemo-induced nausea/vomiting, as studies show that they do little to
delay nausea/vomiting compared with placebo.
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