September 10, 2007
forbes.com (HealthDay News)

Experts Offer Tips on Lung Cancer Prevention

People, especially smokers, should not rely on vitamin and mineral supplements to prevent lung cancer, say members of the American College of Chest Physicians in their second annual guide to lung cancer prevention, care and treatment.

The new evidence-based guidelines also include a strong statement opposing the use of low-dose CT scans for the general screening of lung cancer.

Lung cancer is the leading cause of cancer death in the United States. More people die from lung cancer than from colon, breast, prostate and pancreatic cancer combined.

"Each year, great strides are made in the diagnosis and treatment of lung cancer, allowing patients with the disease to live longer and increase the quality of their lives. However, the real culprit behind lung cancer is tobacco," Dr. Mark J. Rosen, president of the American College of Chest Physicians (ACCP), said in a prepared statement. "Avoiding tobacco is the key to preventing most forms of lung cancer. Until we eliminate tobacco use completely, we will continue to deal with its devastating health consequences."

Published as a supplement to the September issue of the college's journal Chest, the guidelines note there is little evidence to show lung cancer screening changes the outcome for patients, including those considered to be at high risk.

"Even in high-risk populations, currently available research data do not show that lung cancer screening alters mortality outcomes," Dr. W. Michael Alberts, chairman of the ACCP lung cancer guidelines, said in a prepared statement. "We hope that, one day, we can find a useful and accurate tool for general lung cancer screening but, at this time, the evidence does not support the use of LDCT screening."

This is the second edition of Diagnosis and Management of Lung Cancer: ACCP Evidence-Based Clinical Practice Guidelines. The guide contains 260 recommendations, including a review of complementary and integrative therapy for the prevention and treatment of lung cancer.

Due to the lack of supporting evidence, the guidelines recommend against the use of LDCT, chest X-rays or single or serial sputum cytologic evaluation for lung cancer screening in the general population, including smokers or others at high risk. The exceptions are for patients in well-designed clinical trials.

"Population screening for lung cancer is not recommended and may, ultimately, put the patient at risk for further complications," Dr. Gene L. Colice, vice chairman of the ACCP lung cancer guidelines, said in a prepared statement. "Nodules are commonly found during screening; however, to determine whether they are cancerous requires additional testing, which is fairly invasive and extensive. This may cause the patient needless risk, both physically and psychologically."

In terms of prevention, the guidelines recommend against the use of several common supplements and medications in at-risk patients or those with a history of lung cancer. Beta carotene tops the list of supplements that the ACCP recommends against. According to the data, there is a actually a higher incidence of lung cancer in people who use these supplements.

Other supplement recommendations:

• Vitamin A, including isotretinoin, has not been shown to decrease the number of second tumors and actually increases the risk of early death for current smokers.
  
• Vitamin E is not recommended for lung cancer prevention, as studies show that there is no difference in the occurrence of lung cancer between people taking vitamin E and those who are not.
  
• Aspirin has been shown in some studies to play a protective role, but the guidelines do not recommend aspirin for preventing lung cancer. Studies show aspirin does not decrease the risk of death or lung cancer incidence.

This is also the first edition of the guidelines to include recommendations on techniques that can help reduce the anxiety, mood disturbances and chronic pain associated with cancer.

Massage therapy is recommended as a way to reduce anxiety and pain.

Acupuncture is recommended for patients experiencing fatigue, dyspnea and chemo-induced neuropathy. Acupuncture is also recommended for people whose nausea, vomiting or pain is poorly controlled.

Electrostimulation wristbands are not recommended for managing chemo-induced nausea or vomiting. Studies show they do little to delay nausea or vomiting.

A multidisciplinary group of 100 pulmonologists, medical oncologists, radiation oncologists, thoracic surgeons and other health professionals reviewed the 260 recommendations.