From the Guidelines
Lung cancer screening is recommended annually 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, using low-dose computed tomography (LDCT) 1. This recommendation is based on a strong recommendation with moderate-quality evidence from the 2021 Chest guideline and expert panel report. The guideline suggests that annual screening with LDCT should be offered to this group of individuals.
- The screening criteria include:
- Age 55-77 years
- 30 pack-year smoking history
- Current smoker or quit within the past 15 years
- The guideline also suggests that 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.
- For individuals who do not meet the smoking and/or age criteria, but are projected to have a high net benefit from lung cancer screening based on validated clinical risk prediction calculations and life expectancy estimates, annual screening with LDCT may also be considered 1.
- It is essential to have a thorough discussion with the healthcare provider about the benefits, limitations, and potential harms of screening, including false positives that may lead to unnecessary procedures.
- The use of LDCT for lung cancer screening has been shown to improve survival rates, especially when detected at an early stage 1.
From the Research
Recommendations for Lung Cancer Screening using Low-Dose Computed Tomography (LDCT)
- The United States Preventive Services Task Force recommends lung cancer screening with LDCT in adults of age 50 years to 80 years who have at least a 20 pack-year smoking history and are currently smoking or have quit within the past 15 years 2, 3.
- 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 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 3.
Components of a High-Quality Lung-Cancer-Screening Program
- Identification of eligible individuals 2, 4.
- Shared decision-making 2, 4.
- Performing and reporting LDCT results 2, 4.
- Management of screen-detected lung nodules and non-nodule findings 2, 4.
- Smoking cessation 2, 4, 5.
- Ensuring adherence, data collection, and quality improvement 2, 4.
Benefits of Lung Cancer Screening
- Lung cancer screening with LDCT reduces lung cancer deaths by early detection 2, 4, 3.
- Smoking cessation interventions have the potential to greatly enhance the impact of lung cancer screening programs 5.
- Unanticipated diseases identified on LDCT may offer important benefits through early detection of leading global causes of death, such as cardiovascular diseases and chronic obstructive pulmonary disease 4.