ATS Core Curriculum 2021. Adult Pulmonary Medicine: Thoracic Oncology

Our plain-English summary of ATS Core Curriculum 2021. Adult Pulmonary Medicine: Thoracic Oncology, by G.W. Garrison, J.L. Cho, J.C. Deng, et al (ATS Scholar, 2021).

The study

• Authors: G.W. Garrison, J.L. Cho, J.C. Deng, E. Camac, S. Oh, K. Sundar, J.V. Baptiste, G.S. Cheng, J. De Cardenas, C. Fitzgerald, J. Garfield, N.T. Ha, V.K. Holden, O. O'Corragain, S. Patel, M.T. Wayne, J.I. McSparron, T. Wang, B. Çoruh, M.M. Hayes, E. Guzman, C.L. Channick
• Journal: ATS Scholar
• Published: 2021;2(3):468-483
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine at the annual international conference. The 2021 Pulmonary Core Curriculum focuses on lung cancer and include risks and prevention, screening, nodules, therapeutics and associated pulmonary toxicities, and malignant pleural effusions. Although tobacco smoking remains the primary risk factor for developing lung cancer, exposure to other environmental and occupational substances, including asbestos, radon, and burned biomass, contribute to the global burden of disease. Randomized studies have demonstrated that routine screening of high-risk smokers with low-dose chest computed tomography results in detection at an earlier stage and reduction in lung cancer mortality. On the basis of these trials and other lung cancer risk tools, screening recommendations have been developed. When evaluating lung nodules, clinical and radiographic features are used to estimate the probability of cancer. Management guidelines take into account the nodule size and cancer risk estimates to provide recommendations at evaluation. Newer lung cancer therapies, including immune checkpoint inhibitors and molecular therapies, cause pulmonary toxicity more frequently than conventional chemotherapy. Treatment-related toxicity should be suspected in patients receiving these medications who present with respiratory symptoms. Evaluation is aimed at excluding other etiologies, and treatment is based on the severity of symptoms. Malignant pleural effusions can be debilitating. The diagnosis is made by using simple pleural drainage and/or pleural biopsies. Management depends on the clinical scenario and the patient's preferences and includes the use of serial thoracentesis, a tunneled pleural catheter, or pleurodesis.

Copyright © 2021 by the American Thoracic Society.

In plain English

This article was an educational review, part of the American Thoracic Society's 2021 Core Curriculum for clinicians. It covered lung cancer risk factors and prevention, screening, lung nodules, lung damage from cancer treatments, and malignant pleural effusions. It did not study any group of patients or workers. Instead, it summarized other studies and guidelines. The authors described tobacco smoking as the leading risk factor for lung cancer, citing a meta-analysis that reported relative risks of 6.99 for women and 7.33 for men who currently smoked. Asbestos appeared only briefly. The authors listed it among modifiable environmental or occupational risk factors, stated that it contributes to the global burden of lung cancer along with radon and burned biomass, and wrote that radon and asbestos should be avoided. The review gave no asbestos fiber types, exposure levels or asbestos-specific risk figures, and it did not discuss mesothelioma. The authors cited randomized trials of low-dose CT screening in high-risk smokers. One of these, the National Lung Screening Trial, reported a 20% relative reduction in lung cancer death.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative educational review (ATS Core Curriculum) summarizing published studies and guidelines; no original data
• Who was studied: No study population; the article is a review written to update clinicians
• Exposure: Lung cancer risk factors generally, chiefly tobacco smoking. Asbestos is mentioned only as one of several environmental or occupational exposures, with no fiber type, product, job or dose specified
• Main results:
  • The review stated that asbestos, radon and burned biomass, alongside tobacco smoking, contribute to the global burden of lung cancer
  • In its prevention section, the review stated that occupational and household carcinogens, including radon and asbestos, should be avoided
  • Citing a published meta-analysis, the review reported relative risks of lung cancer from current smoking of 6.99 for women and 7.33 for men
  • The review stated that randomized studies had shown that routine low-dose CT screening of high-risk smokers results in earlier-stage detection and reduced lung cancer mortality
  • Citing the National Lung Screening Trial (2011), whose eligibility criteria were based on age and smoking history, the review reported that low-dose CT screening resulted in a 20% relative reduction in lung cancer death
  • The review reported that the 2021 U.S. Preventive Services Task Force guidance recommended screening adults aged 50 to 80 years with a 20 pack-year smoking history
  • Citing other sources, the review reported that malignant pleural effusions affect nearly 15% of patients with cancer, with median survival of 3 to 12 months depending on the type of malignancy
• The authors' conclusion: The authors concluded that tobacco smoking remains the primary risk factor for lung cancer, while environmental and occupational substances including asbestos also contribute to the global burden of disease

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Pleural Effusion, checkpoint inhibitors, Chemotherapy, Thoracentesis, Pleurodesis.

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