From the Guidelines
Asymptomatic smokers should undergo annual low-dose computed tomography (LDCT) screening for lung cancer if they are between 55-77 years old, have a 30 pack-year smoking history, and are either current smokers or have quit within the past 15 years, as this has been shown to reduce lung cancer mortality 1. This recommendation is based on the strongest and most recent evidence from the Chest guideline and expert panel report published in 2021 1. The report suggests that annual screening with low-dose CT should be offered to asymptomatic individuals who meet the specified criteria, as it can detect lung cancer at earlier, more treatable stages, reducing lung cancer mortality by approximately 20% in high-risk individuals.
Some key points to consider when recommending LDCT screening for asymptomatic smokers include:
- Age: 55-77 years old
- Smoking history: 30 pack-years or more
- Current smoking status: current smoker or quit within the past 15 years
- Screening frequency: annual
- Screening method: low-dose computed tomography (LDCT) It is essential to note that these eligibility criteria align with the eligibility criteria for CMS coverage at the time of publication 1. Additionally, the application of risk calculators or life year gained calculators to identify screen-eligible individuals is more burdensome than identification using the criteria alone, and lung cancer screening programs that choose to identify eligible individuals based on this recommendation should develop tools to support ordering providers in identifying screen-eligible individuals 1.
Before beginning screening, patients should have a thorough discussion with their healthcare provider about the benefits, potential harms (including false positives, additional testing, and incidental findings), and smoking cessation strategies, as quitting smoking remains the most effective way to reduce lung cancer risk 1. Patients should be prepared for possible follow-up testing if abnormalities are detected during screening. The benefits of LDCT screening in reducing lung cancer mortality outweigh the potential harms, making it a recommended screening tool for asymptomatic smokers who meet the specified criteria 1.
From the Research
Recommendations for Smokers
- The US Preventive Services Task Force (USPSTF) 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.
- The American Cancer Society (ACS) recommends annual lung cancer screening with lung LDCT for individuals aged 50-80 years who are asymptomatic but who currently smoke or have previously smoked 3.
- 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.
Integration of Smoking Cessation and Lung Cancer Screening
- Smokers who present for lung cancer screening should be encouraged to quit smoking at each visit, and access to evidence-based smoking-cessation interventions should be provided to all smokers regardless of scan results 4.
- Counseling and pharmacotherapy are evidence-based strategies which are well known to help people quit smoking, and integration of cessation resources in screening programs can help screened patients live longer, better lives 5.
- Shared decision-making conversations and smoking cessation interventions are critical components of low-dose CT lung cancer screening programs, and can help patients make informed decisions about screening 6.
Benefits of Lung Cancer Screening
- Lung cancer screening with LDCT reduces lung cancer mortality in individuals with a substantial smoking history 3, 2.
- Early-stage lung cancer has a better prognosis and is more amenable to treatment, making early detection through screening crucial 2.
- Smoking cessation broadens the impact of any lung cancer screening program well beyond the endpoints of cancer diagnosis and cancer mortality to reduce risk from many other diseases 5.