From the Guidelines
The Philippines should adopt annual low-dose computed tomography (LDCT) screening for lung cancer in high-risk individuals, as recommended by the most recent guidelines from the National Comprehensive Cancer Network (NCCN) in 2025 1.
Guidelines for Lung Cancer Screening
The NCCN guidelines recommend annual LDCT screening for adults aged 50-80 years with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years.
- Screening should be conducted at healthcare facilities with experience in lung cancer screening and treatment.
- Before undergoing screening, patients should have a thorough discussion with their healthcare provider about the benefits, limitations, and potential harms of screening, including false positives and radiation exposure.
- The rationale for screening is that early detection of lung cancer significantly improves treatment outcomes and survival rates, as early-stage lung cancers are more amenable to curative treatment.
Importance of Smoking Cessation
- Patients should be aware that screening is not a substitute for smoking cessation, which remains the most effective way to reduce lung cancer risk.
- Smoking cessation counseling should be provided to all current smokers, and all individuals who formerly smoked should be advised to remain abstinent from smoking.
Shared Decision-Making
- A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with LDCT should occur before any decision is made to initiate lung cancer screening.
- Shared decision-making aids may assist in counseling patients about the risks and benefits of screening.
Risk Assessment
- Age and smoking history are used for risk assessment, but other potential risk factors for lung cancer, such as occupational exposure, radon exposure, cancer history, family history, and lung disease history, may be discussed during shared decision-making.
- The NCCN encourages providers to consider using risk calculators, if possible, because additional candidates at high risk for lung cancer may be identified for lung screening.
Quality of Life and Mortality
- The goal of lung cancer screening is to reduce mortality and improve quality of life by detecting lung cancer at an early stage when it is more amenable to curative treatment.
- The NCCN guidelines prioritize the use of LDCT for lung cancer screening, as it has been shown to reduce lung cancer mortality in high-risk individuals.
Current Recommendations
- The current recommendations from the NCCN are based on the most recent evidence and prioritize the use of LDCT for lung cancer screening in high-risk individuals.
- The guidelines emphasize the importance of shared decision-making, smoking cessation, and risk assessment in the context of lung cancer screening.
From the Research
Guidelines for Lung Cancer Screening
The guidelines for lung cancer screening in the Philippines are not explicitly stated in the provided studies. However, the studies provide information on the general guidelines for lung cancer screening that can be applied in various countries, including the Philippines.
- The American Cancer Society recommends annual lung cancer screening with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history 2.
- The National Lung Screening Trial (NLST) showed a significant relative reduction of 20% in lung cancer mortality and 6.7% reduction in total mortality among high-risk smokers who underwent low-dose computed tomography screening 3, 4.
- The European Respiratory Journal recommends lung cancer screening by low-dose computed tomography to be performed in medical centers manned by specialized multidisciplinary teams, as well as for a mandatory, pre-screening, comprehensive discussion with the patient about the risks and advantages involved in the process 4.
- The use of low-dose computed tomography for lung cancer screening can reduce mortality from the disease by 20% in high-risk smokers, but it also raises concerns about false-positive results, overdiagnosis, radiation exposure, and costs 5.
Key Elements of a Successful Lung Cancer Screening Program
A successful lung cancer screening program should include the following key elements:
- Identification of individuals at high risk for lung cancer, such as those with a history of smoking 3, 2.
- Use of low-dose computed tomography for screening 3, 5, 4.
- A comprehensive discussion with the patient about the risks and advantages involved in the screening process 2, 4.
- A shared decision-making approach to screening, taking into account the individual's values and preferences 2, 6.
- Follow-up and management of screening findings, including further imaging or invasive investigations as needed 3, 5.