Doctors can recommend lots of ways for current and former smokers to improve their health — exercise, modify diet, get regular checkups, stop smoking — but low-dose computed tomography (LDCT) to screen for lung cancer isn’t one of them.

That is the conclusion from evidenced-based guidelines just released by the American College of Chest Physicians (ACCP; Northbrook, Illinois) which recommend against the use of LDCT for the general screening of lung cancer. Published as a supplement to the September issue of CHEST, the peer-reviewed journal of ACCP, the guidelines provide support for the view that there is little evidence to show lung cancer screening reduces mortality, including in those patients who are considered at high risk for the disease.

Peter Bach, MD, a pulmonary and critical care physician at Memorial Sloan-Kettering Cancer Center (New York), and author of the screening chapter of the guidelines from ACCP, told Medical Device Daily that multiple randomized trials have demonstrated there is no benefit from CT screening of lung cancer.

“You find a lot more small cancers [with CT], but you don’t find any advanced cancers that are going to kill people sooner,” Bach said.

The cancers that do show up during a CT scan grow so slowly, Bach said, that they don’t actually pose much threat to the patient because they would take 50 to 60 years to result in death.

“Unfortunately most [advanced] lung cancer, when it appears, claims someone’s life very quickly, usually [in] less than a year,” Bach said.

In its second edition, “Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines” provides 260 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.

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.

“Even in high-risk populations, currently available research data do not show that lung cancer screening alters mortality outcomes,” said W. Michael Alberts, MD, chair of the ACCP lung cancer guidelines development group and chief medical officer at H. Lee Moffitt Cancer Center and Research Institute (Tampa, Florida). “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 LDCT screening.”

Bach said most clinicians do not currently order CT to screen for lung cancer, but that the guidelines serve to reassure them of that decision.

So what advice would Bach give to a current or former smoker concerned about their risk of lung cancer?

“In all likelihood most current and former smokers do face some risk of lung cancer,” Bach said, “[but] often people overestimate their risk.”

Rather than depending on a high-tech diagnostic strategy, people should stick to the basics, he said. Exercise, improved diet, regular checkups and not smoking are more practical ways for such patients to improve their health, he said.

“But going and getting an unproven and potentially harmful screening test is not one of them, and it would be a real pity if patients pursue these tests because they think it’ll help and it doesn’t,” he said.

The guidelines also recommend against the use of beta-carotene supplements for lung cancer prevention, citing evidence indicating a higher incidence of lung cancer among those who use the supplement.

And they also recommend against the use of retinoids (vitamin A), including isotretinoin, because they have not been shown to decrease the incidence of second tumors and could increase mortality among current smokers.

Vitamin E is not recommended for lung cancer prevention either because studies show no difference in the incidence of lung cancer among those taking vitamin E compared with those not taking it.

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 from the disease.

The ACCP lung cancer guidelines do, however, recommend mind/body modalities as part of a multi-modality 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, however, are not recommended for managing chemo-induced nausea/vomiting, as studies show that they do little to delay nausea/vomiting compared with placebo.

ACCP said that the recommendations were developed and reviewed by 100 multidisciplinary panel members, including pulmonologists, medical oncologists, radiation oncologists, thoracic surgeons, integrative medicine specialists, oncology nurses, pathologists, healthcare researchers, and epidemiologists.