CA Cancer J Clin ：新指南支持高危个体CT筛查肺癌

　　美国癌症学会(ACS)日前发布指南，支持对部分高危个体采用小剂量CT扫描进行肺癌筛查。这部指南发表在《CA: A Cancer Journal for Clinicians》在线版上(doi: 10.3322/caac.21172)。

　　指南编撰委员会的Richard Wender博士指出：“能够进行大规模、高质量肺癌筛查的临床医生和治疗中心，应当与年龄55~74岁、有至少30包/年吸烟史、目前仍吸烟或戒烟不足15年、身体相对健康者讨论肺癌筛查问题。”

　　这部指南围绕NLST(全国肺部筛查试验)中采用的合格标准提出建议。由于获益与风险之间的平衡情况尚不明确，目前不推荐对年龄更小或更大者、一生中烟草暴露时间更短者，以及肺损伤较严重而需要吸氧者进行肺癌筛查。指南作者承认，如果患者的风险接近或超过NLST合格标准中的某一方面，而不符合标准的其他方面，临床医生就需要自己酌情作出判断。

　　由于公立或私立保险机构很少覆盖首次小剂量CT肺癌筛查，“决定提供筛查的临床医生有责任帮助患者决定是否要自费接受初次筛查，并且帮助患者了解所需支付的金额。鉴于有充分证据表明筛查高危个体可明显降低肺癌死亡率，公立和私立医疗保险机构都应当将高危每年接受(小剂量CT)肺癌筛查的费用纳入赔付范围。”

　　一方面小剂量CT已被证实可显著降低肺癌死亡风险，而另一方面这项技术无法检出所有的肺癌，也无法确保足够早地检出肺癌以避免肺癌死亡。而且，假如筛查得出假阳性结果，有可能促使患者接受侵入性检查。这部指南还警告称，目前吸烟者不能将筛查视为戒烟的替代品。建议目前吸烟者进行咨询，所有符合每年筛查标准者都应仅在愿意接受每年筛查的风险和费用、年龄不足74岁的前提下作出决定。

　　这部指南还指出，胸部X线检查不得被用于肺癌筛查。

　　只要有可能，都应当由小剂量CT筛查方面的专家，以及善于评估、诊断和治疗异常肺部病变的多学科小组，将肺癌筛查作为有序项目中的一部分来加以实施。假如患者强烈希望接受筛查，应将其转至有丰富肺部CT扫描、诊断检查和肺癌手术经验的中心。否则，“肺癌筛查相关风险可能会明显高于在NLST中观察到的风险。”

American Cancer Society lung cancer screening guidelines

Abstract

Findings from the National Cancer Institute's National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30–pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation.