What are the qualifications for getting a low-dose lung cancer screening Computed Tomography (CT) scan?

Lung Cancer Screening Eligibility Criteria

To qualify for low-dose CT lung cancer screening, you must meet ALL of the following criteria: age 50-80 years, at least 20 pack-years of smoking history, currently smoking or quit within the past 15 years, and be asymptomatic without health conditions that would prevent curative lung surgery. 1, 2

Core Eligibility Requirements

Age Criteria

• Minimum age: 50 years (not 49 or younger, regardless of other risk factors) 1
• Maximum age: 80 years 1, 2
• Some guidelines use age 55-77 years based on the original NLST trial parameters 3

Smoking History Requirements

• At least 20 pack-years of smoking exposure (USPSTF 2021 updated criteria) 1, 2
• Alternative threshold: 30 pack-years (older guidelines from NCCN, ACS, IASLC) 3, 1
• Pack-year calculation: 1 pack per day for 20 years = 20 pack-years; 1.5 packs per day for 20 years = 30 pack-years 3, 1

Current Smoking Status

• Currently smoking OR quit within the past 15 years 1, 2
• If you quit more than 15 years ago, you do NOT qualify for screening (unless meeting high-risk calculator criteria) 3

Absolute Exclusions (Do NOT Screen)

Symptomatic Patients

• Presence of any symptoms suggesting lung cancer disqualifies you from screening - these patients need diagnostic testing, not screening 4, 5
• Symptoms include: unexplained weight loss, hemoptysis, persistent cough, chest pain 4

Medical Contraindications

• Comorbidities that substantially limit life expectancy or ability to tolerate curative lung surgery 3, 1, 5
• Examples: advanced COPD requiring home oxygen, NYHA class IV heart failure, advanced liver disease 3
• Metallic implants or devices in chest or back 3
• Prior history of lung cancer 3

Recent Imaging

• Chest CT performed within the past 18 months 1

Important Implementation Requirements

Where to Get Screened

• Screening must be performed at high-volume, high-quality centers with multidisciplinary teams 1, 5
• Centers must have expertise in LDCT interpretation, lung nodule management, and comprehensive diagnostic/treatment services 1

Mandatory Counseling

• You must receive counseling about benefits and harms of screening before proceeding 3, 1
• Current smokers must receive vigorous smoking cessation counseling and referral 1, 5
• Screening is NOT a substitute for smoking cessation 1, 5

Alternative Risk-Based Screening (Not Routinely Recommended)

• Individuals who don't meet standard criteria but have high risk on validated calculators (e.g., PLCOm2012 ≥1.51% 6-year risk) may be considered, but this is NOT routinely recommended 3, 5
• Insurance typically will not cover screening outside standard eligibility criteria 3

Common Pitfalls to Avoid

• Do NOT use chest X-ray for screening - it does not reduce lung cancer mortality 3, 1
• Do NOT screen based solely on family history if under age 50 - this violates all established guidelines 1
• Do NOT use screening protocols for symptomatic patients - they need diagnostic CT, not low-dose screening CT 4
• Discontinue screening once you haven't smoked for 15 years 5, 2