NCCN临床实践指南_肺癌筛查（2019.V1）英文版

Lung Cancer Screening Version 1 2019 June 11 2018 NCCN org NCCN Guidelines for Patients available at www nccn org patients NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Continue Version 1 2019 06 11 18 National Comprehensive Cancer Network Inc 2018 All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN Douglas E Wood MD Chair University of Washington Seattle Cancer Care Alliance Ella A Kazerooni MD MS Vice Chair University of Michigan Rogel Cancer Center Scott L Baum MD The University of Tennessee Health Science Center George A Eapen MD The University of Texas MD Anderson Cancer Center David S Ettinger MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Lifang Hou MD PhD 162 485 491 Updates in Version 1 2019 of the NCCN Guidelines for Lung Cancer Screening from Version 3 2018 include NCCN Guidelines Index Table of Contents Discussion Version 1 2019 06 11 18 National Comprehensive Cancer Network Inc 2018 All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Version 1 2019 Lung Cancer Screening Printed by Maria Chen on 6 12 2018 10 45 26 PM For personal use only Not approved for distribution Copyright 2018 National Comprehensive Cancer Network Inc All Rights Reserved LCS 1 Smoking historyc Radon exposured Occupational exposuree Cancer historyf Family history of lung cancer in first degree relatives Disease history COPD or pulmonary fibrosis Smoking exposureg second hand smoke Absence of symptoms or signs of lung cancer if symptoms see appropriate NCCN Guidelines Functional status to support curative intent treatment Lung cancer survivors see Surveillance in the NCCN Guidelines for Non Small Cell Lung Cancer RISK ASSESSMENTa bRISK STATUS aIt is recommended that institutions performing lung cancer screening use a multidisciplinary approach that includes the specialties of thoracic radiology pulmonary medicine and thoracic surgery bLung cancer screening is appropriate to consider for high risk patients who are potential candidates for definitive treatment Chest x ray is not recommended for lung cancer screening cAll current smokers should be advised to quit smoking and former smokers should be advised to remain abstinent from smoking For additional cessation support and resources smokers can be referred to http www smokefree gov Lung cancer screening should not be considered a substitute for smoking cessation Smoking history should document both extent of exposure in pack years and the amount of time since smoking cessation in former smokers See also the NCCN Guidelines for Smoking Cessation dDocumented sustained and substantially elevated radon exposure eAgents that are identified specifically as carcinogens targeting the lungs silica cadmium asbestos arsenic beryllium chromium diesel fumes nickel coal smoke and soot fThere is increased risk of developing new primary lung cancer among survivors of lung cancer lymphomas cancers of the head and neck or smoking related cancers gIndividuals exposed to second hand smoke have a highly variable exposure to the carcinogens with varying evidence for increased risk after this variable exposure Therefore second hand smoke is not independently considered a risk factor for lung cancer screening hAlthough randomized trial evidence supports screening to age 74 years there is uncertainty about the upper age limit to initiate or continue screening One can consider screening beyond age 74 years as long as patient functional status and comorbidity allow consideration for curative intent therapy iThe NCCN Panel recognizes there are individuals who would not have met the NLST criteria but are at similar risk to the NLST cohort and recommends lung cancer screening for these individuals However substantial uncertainty exists about the true benefits and harms of screening these individuals It is reasonable to consider using the Tammemagi lung cancer risk calculator to assist in quantifying risk for individuals in this group considering a 1 3 threshold of lung cancer risk over a 6 year timeframe was considered similar to that of the USPSTF Tammem gi MC Church TR Hocking WG et al Evaluation of the lung cancer risks at which to screen ever and never smokers screening rules applied to the PLCO and NLST cohorts PLOS Med 2014 11 1 13 jShared decision making aids may assist in determining if screening should be performed Examples of decision making aids https brocku ca lung cancer risk calculator http www shouldiscreen com benefits and harms screening and https www mskcc org cancer care types lung screening lung screening decision tool kAll screening and follow up chest CT scans should be performed at low dose 100 120 kVp and 40 60 mAs or less unless evaluating mediastinal abnormalities or lymph nodes where standard dose CT with IV contrast might be appropriate see LCS A T