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From JAMA |

Evidence at the Point of Practice Change

George F. Sawaya, MD; Jeffrey A. Tice, MD
Arch Intern Med. 2012;172(18):1415-1417. doi:10.1001/archinternmed.2012.4287.
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Among the most difficult decisions made by clinicians and policymakers is determining when a new test or treatment should be integrated into routine medical practice. Attention has turned again to lung cancer screening. Bach et al1 have provided a comprehensive overview of the current evidence regarding the benefits and harms of low-dose computed tomography (LDCT) for lung cancer screening. The work is notable for its rigorous approach and its thoughtful discussion of the range of current unanswered questions. The authors conclude that LDCT may provide benefit for those at increased risk, but uncertainty exists about potential screening harms and the generalizability of results. The report formed the foundation for a clinical practice guideline by the American College of Chest Physicians and the American Society of Clinical Oncology. They jointly recommend that annual screening with LDCT be offered at select centers to smokers and former smokers aged 55 to 74 years who have smoked for 30 pack-years or more and either continued to smoke or have quit within the past 15 years. Can we reconcile a recommendation to offer screening in the face of numerous uncertainties, especially screening harms and costs?

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