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(Chest. 2005;127:1146-1151.)
© 2005 American College of Chest Physicians

Como International Conference Position Statement*

Lung Cancer Screening for Early Diagnosis 5 Years After The 1998 Varese Conference

Gary M. Strauss, MD, MPH; Lorenzo Dominioni, MD; James R. Jett, MD; Matthew Freedman, MD, MBA and Frederic W. Grannis, Jr, MD{dagger}

* From the Division of Medical Oncology (Dr. Strauss), Brown Medical School and Rhode Island Hospital, Providence, RI; Center for Thoracic Surgery (Dr. Dominioni), University of Insubria, Varese, Italy; the Division of Pulmonary Medicine (Dr. Jett), Mayo Clinic, Rochester, MN; Imaging Science and Information Systems Research Center (Dr. Freedman), Department of Oncology, Georgetown University, Washington, DC; and the Department of Thoracic Surgery (Dr. Grannis), City of Hope National Medical Center, Duarte, CA. {dagger} Cosponsors of the Como International Conference include Facoltà di Medicina e Chirurgia, University of Insubria, Varese, Italy; the Department of Medicine, Rhode Island Hospital and Brown Medical School, Providence, RI; and the American Cancer Society, Atlanta, GA. This position statement, however, has not received the endorsement of the American Cancer Society.

Correspondence to: Gary M. Strauss, MD, MPH, Division of Medical Oncology, Rhode Island Hospital, Brown Medical School, 593 Eddy St, Providence, RI 02903; e-mail: gstrauss{at}lifespan.org

Background: Lung cancer is the most common cause of cancer death in the world. Nonetheless, public policy organizations have consistently recommended against screening for lung cancer, with the result that screening is not widely practiced. The Como Conference was undertaken to consider the need for a change in the existing recommendations against screening.

Purpose: The primary objective of the Como Conference was to consider whether there is sufficient scientific evidence to advise screening for lung cancer among asymptomatic individuals outside the context of a clinical trial. Methodological issues that are relevant to the proper interpretation of early detection trials were carefully considered. Advantages and problems associated with technological advances in CT scans and digital chest radiographs (CXRs) were fully explored. Economic issues relevant to screening were also considered.

Recommendations: It is recommended that physicians assume responsibility for informing high-risk individuals regarding options for screening for lung cancer. Targeted high-risk individuals include middle-aged or elderly men and women who are current or former cigarette smokers of > 20 to 30 pack-years without serious medical comorbidities. It is recommended that such persons be informed that symptomatic lung cancer is usually advanced and incurable, while surgery for early lung cancer offers a far better chance of cure. They should also be informed about advances in imaging technology, as they relate to CT scans and CXRs.

Conclusions: Whenever possible, high-risk individuals should be encouraged to enroll in ongoing trials. For subjects who, though eligible, do not have access to such trials, a process of shared decision-making between physicians and at-risk individuals is strongly recommended. After discussion of the existing state of knowledge, high-risk individuals should be made aware that it is reasonable for them to choose to undergo testing for lung cancer.

Key Words: chest roentgenogram • cigarette smoking • computed tomography • consensus statement • early detection • lung cancer • mortality • overdiagnosis bias • screening • survival




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