Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Restate the USPSTF guidance on screening for lung cancer 2. Discuss the risks and benefits of lung cancer screening
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 07/15/2021 through 07/15/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours.
The current USPSTF guidelines recommend annual cancer
screening using low-dose CT. Lung cancer has a poor prognosis and is the third
most common type of non-skin cancer in the United States. Lung cancer is the
leading cause of cancer death in men and in women. The USPSTF recommends (Grade
B – offer or provide this service)
Screen annually for lung cancer with low-dose computed tomography
Discontinue screening when the patient has not smoked for 15 years or or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit smoking within the past 15 years
Risk Factors for Lung Cancer
Most important factors
Age | Incidence relatively low in individuals under 50 and increases with age, especially >60 years
Total cumulative exposure to tobacco smoke
Years since quitting smoking
Additional risk factors
Prior radiation therapy
Other (noncancer) lung diseases
High sensitivity and acceptable specificity in high-risk populations persons
Balance of Benefits vs Harms
Annual screening for lung cancer with low-dose
CT is of moderate net benefit in asymptomatic persons who are at high risk for
lung cancer based on age, total cumulative exposure to tobacco smoke, and years
since quitting smoking
Evidence of Benefit for low-dose CT
Large RCT – National Lung Screening Trial (NLST)
is cited as the study demonstrating clinical utility
55 to 74 years
Cigarette smoking histories of ≥30
or more pack-years and who, if they are former smokers, have quit within the
last 15 years
Results: Low-dose CT
Reduces lung cancer mortality by 20% (95% CI,
6.8–26.7; P = .004)
Reduces all-cause mortality by 6.7% (95% CI,
1.2–13.6; P = .02)
Updated analysis: Lung cancer reduction of 16%
Primarily harm is risk for false-positive low-dose CT | Majority of positive results do not lead to a diagnosis and up to 96% of positive exams may not result in cancer detection | In a high-quality screening program, further imaging can resolve most, although not all, false-positive results
Overdiagnosis can be up to 30% depending on screening population per heterogenous meta-analysis (NCI)
Radiation Exposure from CT
The NELSON Trial (NEJM, 2020)
The NELSON RTC demonstrated that at 10 years of follow-up, screening with volume CT imaging
Reduced lung-cancer mortality by 24% among men and by 33% among women in high-risk populations
Reduced overdiagnosis to 10%
Improved PPV to 43.5%
Calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person has smoked
1 pack = 20 cigarettes
1 pack (20 cigarettes) per day for 1 year = 1 pack-year
2 packs (40 cigarettes) per day for half a year = 1 pack-year
½ pack (10 cigarettes) per day for 20 years = 10 pack-years
Recommendations of Other Professional Societies
American Society of Clinical Oncology
People age 55 to 74 who have smoked for 30 pack-years or more | Also recommended for those age 55 to 74 who have quit within the past 15 years
CT screening not recommended: Smoked for less than 30 pack-years | Younger than 55 or older than 74 | Quit smoking more than 15 years ago | Have a serious condition that could affect cancer treatment or shorten a person’s life
The American Association for Thoracic Surgery
Age 55 to 79 years with ≥30 pack-year smoking history
Long-term lung cancer survivors who have completed 4 years of surveillance without recurrence, and who can tolerate lung cancer treatment in order to detect second primary lung cancer until the age of 79
Age 50 to 79 years with a 20 pack-year smoking history and additional comorbidity that produces a cumulative risk of developing lung cancer ≥5% in 5 years
American College of Chest Physicians
Age 55 to 77 years with ≥30 pack-year smoking history and either continue to smoke or have quit within the past 15 years
Annual screening Age 55 to 77 with ≥30 pack-year smoking history and smoking cessation <15 years
Age ≥50 years and ≥20 pack-year history of smoking and have at least 1 additional risk factor for lung cancer
American Cancer Society
Age 55 to 74 years, currently smoke or have quit within the past 15 years, and
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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