The American College of Chest Physicians (ACCP) has released guidelines indicating that routine screening for lung cancer with computerized tomography (CT) scanning and other methods are generally not warranted outside of research studies.

In a larger, accompanying report, the ACCP lists 260 recommendations that should be followed in the prevention, screening, diagnosis, staging, and treatment of lung cancer.

Both sets of guidelines, prepared by 100 multi-disciplinary members of the American College of Chest Physicians, have been published in a supplement to the journal Chest.

After reviewing findings of previous studies, the research team, led by Dr Peter B Bach, from Memorial Sloan-Kettering Cancer Center in New York, the United States, concluded that screening with CT imaging or certain sputum tests simply did not reduce lung cancer deaths, even in high-risk groups, such as heavy smokers.

According to the investigators, one of the problems is that current research on CT and sputum screening has focused primarily on lung cancer detection rates, not on whether patient outcomes are actually improved. Studies addressing this question are under way, but the answers will not be available for years.

Based on a lack of solid evidence supporting the following practices, the American College of Chest Physicians makes three recommendations:

Do not use CT to screen for lung cancer outside of trial settings.
Do not use chest X-rays to screen for lung cancer.
Do not use sputum tests to screen for lung cancer.

According to Gene L Colice, vice-chairman of the ACCP lung cancer guidelines, population screening for lung cancer is not recommended and may, ultimately, put the patient at risk for further complications.

Dr W Michael Alberts, Chief Medical Officer of H Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, the United States, cautioned that even in high-risk populations, research data currently available do not show that lung cancer screening alters mortality outcomes.

The ACCP guidelines also advise against the use of vitamins, particularly beta-carotene, vitamin A, and vitamin E, as a means of preventing lung cancer. Use of case of beta-carotene may actually increase the risk of the cancer.

According to the report, there is also no solid evidence that aspirin helps prevent lung cancer or reduces lung cancer deaths.

By contrast, for the first time, the ACCP guidelines support the use of certain alternative treatments as in addition to conventional therapy. Massage therapy is recommended when anxiety or pain is present, and acupuncture is advised for fatigue, shortness of breath, and poorly controlled nausea and vomiting.

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