From the Guidelines
Lung cancer screening should generally stop at age 80. The U.S. Preventive Services Task Force recommends annual screening with low-dose computed tomography (LDCT) for adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years 1.
Key Considerations
- Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery 1.
- The benefits of screening tend to diminish with advanced age, while the risks of complications from follow-up procedures remain the same or increase 1.
- As people age, they are more likely to have other health conditions that might make treatment for lung cancer more difficult or risky 1.
Screening Recommendations
- The U.S. Preventive Services Task Force makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms 1.
- The USPSTF recognizes that clinical decisions involve more considerations than evidence alone, and clinicians should understand the evidence but individualize decision making to the specific patient or situation 1.
Evidence Summary
- The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years 1.
- Low-dose computed tomography has shown high sensitivity and acceptable specificity for the detection of lung cancer in high-risk persons 1.
Patient Factors
- Age, total exposure to tobacco smoke, and years since quitting smoking are important risk factors for lung cancer and were used to determine eligibility in the NLST 1.
- Other risk factors include specific occupational exposures, radon exposure, family history, and history of pulmonary fibrosis or chronic obstructive lung disease 1.
From the Research
Lung Cancer Screening Age Recommendations
- The US Preventive Services Task Force recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years 2.
- Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery 2.
- Guidelines recommend that lung cancer screening be considered in adults aged 55 to 80 years who are at high risk based on smoking history (ie, 30-pack-year smoking history; having smoked within the past 15 years) 3.
Considerations for Stopping Lung Cancer Screening
- The decision to stop screening must take into account patients' age, overall health and life expectancy, the natural history of the disease, and the risks, expense, and convenience of the screening test, and any subsequent testing and treatment 4.
- Evidence suggests that cessation of breast cancer screening at approximately 75 to 80 years of age is appropriate, although American Geriatric Society guidelines recommend cessation at a more advanced age 4.
- Studies support continuing colon cancer screening until approximately 75 years of age in men and 80 years of age in women for patients without significant comorbidities 4.
Economic Evaluation of Lung Cancer Screening
- Low-dose computed tomography (LDCT) screening may be clinically effective in reducing lung cancer mortality, but there is considerable uncertainty 5.
- There is evidence that a single round of screening could be considered cost-effective at conventional thresholds, but there is significant uncertainty about the effect on costs and the magnitude of benefits 5.
- The incremental cost-effectiveness ratio for a single screen in smokers aged 60-75 years with at least a 3% risk of lung cancer is £28,169 per quality-adjusted life-year (QALY) 5.