We very much welcomed the article on follow-up for cancer patients and consider it an important overview (1).
We do, however, feel obliged to point out a misinterpretation in the section about follow-up for patients with lung cancer.
In a subitem to the current follow-up recommendations, the authors explain the studies of follow-up for patients with lung cancer that are cited in the current German clinical practice guidelines for lung cancer (2). But they then recommend annual, low-dose computed tomography (CT) screening for the detection of recurrences or secondary cancers (i.e. secondary prevention) in high-risk patients with curatively treated cancer. They refer to a mortality reduction observed in participants of the National Lung Screening Trial (NLST) receiving a CT scan as compared to those who underwent a chest X-ray. The NLST is a large primary prevention study (3).
In our opinion, this conclusion can be drawn only for the risk group defined in the NLST. We are not aware of any study showing a survival benefit as a result of annual low-dose CT screening in curatively treated lung cancer patients.
In the NLST, three annual low-dose CT scans were undertaken in study participants who had not had lung cancer to date—pre-existing lung cancer, surgery to the lung, or a CT scan 18 months prior to inclusion in the study were exclusion criteria for participation in the NLST (4).
The existence of a further risk factor—such as a history of lung cancer or other tumors associated with smoking, exposure to asbestos, chronic obstructive pulmonary disease, or lung fibrosis—probably increases the risk for lung cancer, but the benefit in terms of a significant reduction in mortality as a result of low-dose CT screening has thus far not been confirmed.
Dr. med. Armin Frille
Abteilung für Pneumologie
Prof. Dr. med. Hubert Wirtz
Abteilung für Pneumologie
Conflict of interest statement
Professor Wirtz received consultancy fees from MSD, Roche, and Boehringer Ingelheim. He was reimbursed for conference registration fees by Boehringer Ingelheim. He received lecture honoraria from MSD, Boehringer Ingelheim, Roche, and Astra Zeneca. He received funding from Roche for a study project he himself initiated. For conducting clinical studies he received honoraria from MSD.
Dr. Frille declares that no conflict of interest exists.
|1.||Dührsen U, Deppermann KM, Pox C, Holstege A: Evidence-based follow-up for adults with cancer. Dtsch Arztebl Int 2019; 116: 663–9 VOLLTEXT|
|2.||Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft DK, AWMF): Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms, Langversion 1.0, AWMF-Registernummer: 020/007OL, http://leitlinienprogramm-onkologie.de/Lungenkarzinom.98.0.html (last accessed on 29 November 2019).|
|3.||National Lung Screening Trial Research Team: Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365: 395–409 CrossRef MEDLINE PubMed Central|
|4.||National Lung Screening Trial Research Team: The National Lung Screening Trial: overview and study design. Radiology. 2011; 258: 243–53 CrossRef MEDLINE PubMed Central|