From the Guidelines
Lung cancer screening is recommended for adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years, with annual screening using low-dose computed tomography (LDCT) (1). The recommendation is based on the findings of the National Lung Screening Trial, which showed a 20% reduction in lung cancer mortality in the LDCT arm compared to the chest X-ray arm (1). Key considerations for lung cancer screening include:
- Age: 55 to 80 years
- Smoking history: 30 pack-year or more
- Current smoking status: current smoker or quit within the past 15 years
- Screening modality: low-dose computed tomography (LDCT)
- Screening frequency: annual
- Importance of shared decision-making: patients should have a thorough discussion with their healthcare provider about the benefits, limitations, and potential harms of screening, including false positives that may lead to unnecessary procedures (1). It is essential to note that lung cancer screening should be performed in a high-volume, high-quality setting with access to a multidisciplinary team skilled in the evaluation, diagnosis, and treatment of lung cancer (1). Additionally, the U.S. Preventive Services Task Force recommends annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years (1). The American Cancer Society also recommends lung cancer screening with LDCT in high-risk populations, including those with a 30 pack-year smoking history and current or former smokers who have quit within the past 15 years (1). Overall, the evidence supports the use of LDCT for lung cancer screening in high-risk populations, with a focus on shared decision-making and high-quality screening programs (1).
From the Research
Lung Cancer Screening Guidelines
- The United States Preventive Services Task Force (USPSTF) recommends annual lung cancer screening with low-dose computed tomography (LDCT) for smokers aged between 55 years to 80 years, with at least 30 pack-years of smoking exposure that currently smoke or who have quit smoking within 15 years 2.
- Risk-based lung cancer screening is an alternative approach that defines screening eligibility based on the personal risk of individuals, which can improve the sensitivity and specificity associated with the eligibility criteria of the screening program 2.
- Numerous risk prediction models have been developed to estimate the lung cancer risk of individuals, incorporating sociodemographic, smoking, and clinical risk factors associated with lung cancer 2.
Screening Eligibility
- The USPSTF criteria for lung cancer screening include age (55-80 years), smoking history (at least 30 pack-years), and current smoking status or quit time (within 15 years) 2.
- Risk prediction models can be used to select individuals for lung cancer screening based on their personal lung cancer risk, which can improve the effectiveness of the screening program 2.
Screening Methods
- Low-dose computed tomography (LDCT) is the recommended screening method for lung cancer, which has been shown to reduce lung cancer specific mortality 2, 3.
- Thin-section LDCT reconstruction combined with artificial intelligence (LDCT-TRAI) has been shown to be effective in detecting early-stage lung cancer in non-high-risk populations 4.
Radiation Exposure and Cancer Risk
- The cumulative radiation exposure from low-dose CT scans for lung cancer screening is relatively low, with a median cumulative effective dose of 9.3 mSv for men and 13.0 mSv for women over 10 years 5.
- The lifetime attributable risk of cancer incidence associated with lung cancer screening using annual low-dose CT is estimated to be low, with a range of 5.5 to 1.4 per 10,000 people screened for lung cancer and 8.1 to 2.6 per 10,000 people screened for major cancers 5.