What are the qualifications for low-dose Computed Tomography (CT) scans for smokers?

From the Guidelines

Low-dose CT scans for lung cancer screening are recommended for asymptomatic individuals aged 55-77 who have smoked 30 pack years or more and either continue to smoke or have quit within the past 15 years, as well as for those aged 50-80 with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years, as outlined in the 2021 Chest guideline and expert panel report 1.

Key Recommendations

• Asymptomatic individuals aged 55-77 with a 30 pack-year smoking history should be offered annual screening with low-dose CT, as this aligns with the eligibility criteria for CMS coverage and has a strong recommendation based on moderate-quality evidence 1.
• Those aged 50-80 with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years should also be considered for annual screening with low-dose CT, although this has a weak recommendation based on moderate-quality evidence 1.

Considerations for Screening

• The decision to undergo screening should be made after a thorough discussion with a healthcare provider about the benefits, limitations, and potential harms of screening, including false positives that may lead to unnecessary procedures.
• Insurance coverage, including Medicare, is generally available for those meeting the specified criteria, though specific coverage details may vary.
• The application of risk calculators or life year gained calculators to identify screen-eligible individuals may be more burdensome but can lead to greater equity across race and sex in eligibility for lung cancer screening and the net benefits of screening 1.

Important Notes

• Asymptomatic refers to the absence of symptoms that suggest the presence of lung cancer.
• Molecular biomarkers are being developed to assist with risk prediction and/or early lung cancer detection but have not yet reached a phase of evaluation to be included in these recommendations 1.

From the Research

Qualifications for Low-Dose CT Scans 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 Center for Medicare and Medicaid Services has approved lung screening as a benefit for patients ages 55 to 77 years who have a 30 pack-year history 3.
• To be eligible for low-dose CT scans, smokers should meet the following criteria:
  • Be between 50 to 80 years old 2
  • Have a 20 pack-year smoking history 2
  • 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.

Benefits of Low-Dose CT Scans for Smokers

• Annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking 2.
• Lung cancer screening can reduce disease-specific mortality in (former) smokers when stringent requirements and quality standards for performance are met 4.
• Low-dose CT screening of high-risk patients enables detection of lung cancer at an early stage and can reduce the risk of dying from lung cancer 5.

Impact of Low-Dose CT Scans on Smoking Behavior

• Lung cancer screening provides an opportunity for smoking cessation interventions 6.
• Smokers who participated in lung cancer screening had a higher smoking cessation rate compared with smokers in the general population 6.
• Individuals who received abnormal CT results had a higher smoking cessation rate compared with participants with normal CT results 6.