What are the guidelines for lung cancer screening using Low-Dose Computed Tomography (LDCT)?

From the Guidelines

Lung cancer screening is recommended for adults aged 55-80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years, using low-dose computed tomography (LDCT) annually. This recommendation is based on the findings of the National Lung Screening Trial and is supported by various organizations, including the American Cancer Society and the National Comprehensive Cancer Network 1. A pack-year is calculated by multiplying the number of packs smoked per day by the number of years smoked. For example, smoking one pack daily for 30 years or two packs daily for 15 years both equal 30 pack-years.

Key Considerations for Lung Cancer Screening

• Screening should be discontinued once a person has not smoked for 15 years, reaches 80 years of age, or develops a health problem that substantially limits life expectancy or the ability to undergo curative lung surgery.
• LDCT screening is effective because it can detect lung cancer at earlier stages when treatment is more likely to be successful, potentially reducing lung cancer mortality by 20-25% 1.
• Before beginning screening, patients should have a thorough discussion with their healthcare provider about the benefits, limitations, and potential harms of screening, including false positives and incidental findings that may lead to additional testing 1.
• The American College of Radiology recommends that LDCT screening be performed with a slice width of 1.0 mm or less, and that the Lung-RADS structured reporting and management system be used to improve the detection of lung cancer and decrease the false-positive rate 1.

Additional Risk Factors

• Patients with additional risk factors for lung cancer, such as radon exposure, occupational exposure, cancer history, family history of lung cancer, history of COPD, or history of pulmonary fibrosis, may also benefit from LDCT screening 1.
• However, the decision to screen these patients should be made on a case-by-case basis, taking into account their individual risk factors and medical history.

Shared Decision-Making

• Shared decision-making is important when a patient begins a program of annual lung cancer screening, especially for those with comorbid conditions 1.
• Patients should be informed of their continuing risk of lung cancer and the potential benefits and harms of screening, and should be encouraged to make an informed decision about whether to undergo screening.

From the Research

Guidelines for Lung Cancer Screening using Low-Dose Computed Tomography (LDCT)

• The US Preventive Services Task Force (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 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.
• The benefits of LDCT screening include a reduction in lung cancer mortality, with an approximate 20% reduction in lung cancer deaths 3.
• The harms of LDCT screening include radiation exposure, psychosocial stress, and invasive examinations triggered by false-positive screening tests and overdiagnosis 3.
• Risk prediction models can be used to identify individuals who are at high risk of lung cancer and may benefit from screening, and can help to improve the overall net benefit of lung cancer screening 3, 4.
• The use of risk prediction models can help to identify a larger number of lung cancer patients for an equivalent number of individuals to be screened, and can provide security that screening participants will all have a high-enough lung cancer risk to balance out harm potentially caused by radiation or false-positive screening tests 3.
• Screening individuals at aged 50 or 55 years through aged 80 years with 20 pack-years or more of smoking exposure was estimated to result in more benefits than the 2013 USPSTF-recommended criteria and less disparity in screening eligibility by sex and race/ethnicity 5.
• Smoking cessation interventions have the potential to greatly enhance the impact of lung cancer screening programs, and can reduce lung cancer mortality and delay overall deaths versus screening only 6.

Eligibility Criteria

• The USPSTF recommends using the following eligibility criteria for lung cancer screening with LDCT:
  • Age: 50 to 80 years
  • Smoking history: 20 pack-years or more
  • Current smoking status: currently smoke or have quit within the past 15 years 2.
• Alternative eligibility criteria, such as risk prediction models, can also be used to identify individuals who are at high risk of lung cancer and may benefit from screening 3, 4.

Screening Frequency and Duration

• The USPSTF recommends annual screening for lung cancer with LDCT in adults who meet the eligibility criteria 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.
• The optimal screening frequency and duration may vary depending on individual risk factors and screening results, and should be determined on a case-by-case basis 5.