What are the computed tomography (CT) screening recommendations for a smoker?

From the Guidelines

Annual low-dose CT screening is recommended for adults aged 55-80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. This recommendation is based on the evidence from the U.S. Preventive Services Task Force 1, which suggests that screening should continue annually until the person has quit smoking for 15 years, reaches age 80, develops a health problem that substantially limits life expectancy, or becomes unwilling to undergo curative lung surgery. A pack-year is calculated by multiplying the number of packs smoked per day by the number of years smoked.

The importance of this screening lies in its ability to detect lung cancer at earlier stages when treatment is more effective, potentially reducing lung cancer mortality by 20-25% 1. The low-dose CT uses less radiation than conventional CT scans while still providing detailed images of the lungs. Patients should discuss their individual risk factors with their healthcare provider, as those with additional risk factors like family history of lung cancer or occupational exposures may benefit from screening even if they don't meet all standard criteria.

Some guidelines also suggest that screening may be beneficial for adults aged 50-79 years who have a 20 pack-year smoking history and additional comorbid conditions that produce a cumulative risk for cancer of at least 5% over the next 5 years 1. However, the most recent and highest quality evidence supports the recommendation for adults aged 55-80 with a 30 pack-year smoking history 1. Insurance typically covers this screening for eligible individuals, though coverage details may vary.

Key points to consider:

• Screening should be done annually with low-dose CT scans
• Eligible individuals include those aged 55-80 with a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
• Screening should continue until the person meets certain criteria, such as quitting smoking for 15 years or reaching age 80
• Patients should discuss their individual risk factors with their healthcare provider to determine the best course of action.

From the Research

CT Screening Recommendations for Smokers

• 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.
• The recommendation is based on a systematic review of the accuracy of screening for lung cancer with LDCT and a collaborative modeling study to provide information about the optimum age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies 2.
• The USPSTF concludes with moderate certainty that 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.

Eligibility Criteria

• 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 are eligible for annual LDCT screening 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.
• Current smokers with less than 20 pack-years of smoking are not recommended for annual LDCT screening, but may still be at high risk of lung cancer 3.

Benefits and Harms of Screening

• Annual screening for lung cancer with LDCT has been shown to have a moderate net benefit in persons at high risk of lung cancer 2.
• The benefits of screening include early detection and treatment of lung cancer, which can improve survival rates 2.
• The harms of screening include false positives, overdiagnosis, and radiation exposure 2.
• 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.