From the Guidelines
The screening test that requires an individualized discussion of risks and benefits prior to ordering for patients with a smoking history is low-dose computed tomography (LDCT) for lung cancer screening. According to the USPSTF, as stated in the 2014 recommendation statement 1, this screening is recommended for adults who have a significant smoking history. Before ordering LDCT, healthcare providers should engage patients in a thorough discussion about potential benefits versus harms, including the risk of false positives, incidental findings, radiation exposure, and potential overdiagnosis 1. The American Cancer Society also supports this approach, emphasizing the importance of informed and shared decision-making with a clinician before initiating lung cancer screening with LDCT 1. This individualized approach is necessary because while LDCT can reduce lung cancer mortality in high-risk individuals, the benefits must be weighed against the psychological impact of false positives and the risks of unnecessary invasive procedures that may follow abnormal findings. Key points to consider in this discussion include:
- The patient's smoking history and current smoking status
- The potential benefits of screening, including early cancer detection and reduced mortality
- The potential harms of screening, including false positives, incidental findings, and radiation exposure
- The importance of smoking cessation counseling for current smokers
- The need for shared decision-making and informed consent before initiating screening.
From the Research
Screening Test Requiring Individualized Discussion
The U.S. Preventive Services Task Force (USPSTF) advises an individualized discussion of risks and benefits prior to ordering a screening test for lung cancer using low-dose computed tomography (LDCT) [ 2, 3 ].
Key Considerations for LDCT Screening
- The patient has a 10-pack-year smoking history and quit 20 years ago, which may still put him at risk for lung cancer [ 2 ].
- The USPSTF recommends annual screening for lung cancer with 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 [ 4 ].
- However, the patient's smoking history and other risk factors should be taken into account when deciding whether to screen [ 5 ].
- The benefits and harms of LDCT screening, including the risk of false positives, overdiagnosis, and radiation exposure, should be discussed with the patient [ 6 ].
Patient-Specific Factors
- The patient's family history of type 2 diabetes is not directly relevant to lung cancer screening, but his smoking history and age are important factors to consider [ 2 ].
- The patient's regular exercise and Mediterranean diet may have a positive impact on his overall health, but do not directly affect the decision to screen for lung cancer [ 3 ].