What are the indications to discontinue screening for lung cancer in a patient with (Pulmonary) compromised lung function?

From the Guidelines

Lung cancer 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. This recommendation is based on the U.S. Preventive Services Task Force (USPSTF) guidelines, which suggest that screening should be stopped when the potential benefits no longer outweigh the harms 1. The indications to discontinue screening for lung cancer in a patient include:

• Not having smoked for 15 years
• Developing a health problem that substantially limits life expectancy
• Developing a health problem that limits the ability to have curative lung surgery
• Being unwilling to have curative lung surgery The USPSTF guidelines are based on the evidence of both the benefits and harms of lung cancer screening with low-dose computed tomography (LDCT) 1. The guidelines recognize that clinical decisions involve more considerations than evidence alone and that clinicians should individualize decision making to the specific patient or situation. The rationale for discontinuing screening is that it carries risks, including radiation exposure, false positives leading to unnecessary procedures, overdiagnosis, and psychological distress, which may outweigh the benefits in certain patients 1.

From the Research

Indications to Discontinue Screening for Lung Cancer

The decision to discontinue screening for lung cancer in a patient involves several factors, including the patient's age, life expectancy, and overall health status.

• Age: Screening until the age of 80 was shown to be efficient in terms of cancer deaths averted; however, stopping at a younger age (e.g., 75) may have greater efficiency in terms of life years gained relative to overdiagnosis 2.
• Life expectancy: The risk of being over-diagnosed is likely to increase rapidly above the age of 75, especially among continuing long-term smokers 2.
• Health status: Deciding when to stop cancer screening in older adults is a complex challenge that involves multiple factors, including individual health status and life expectancy, risks and benefits of screening, which vary with age and comorbidity, and individual preferences and values 3.

Considerations for Discontinuing Screening

When considering discontinuing lung cancer screening, the following factors should be taken into account:

• The patient's residual life expectancy and overall health status 2, 3.
• The potential harms of screening, including false-positive results, procedures from false positives, procedural complications, and failure to adhere to follow-up recommendations 4.
• The patient's individual preferences and values regarding screening and treatment 3.

Tools and Frameworks for Decision-Making

Several tools and frameworks can guide decision-making when considering discontinuing lung cancer screening, including:

• Risk prediction models based on smoking history, sex, and age as a continuous risk factor 2.
• Concise criteria for screening eligibility, such as those used in the NLST or NELSON trials 2.
• Practical frameworks for guiding discussions on when the harms of screening likely outweigh the benefits 3.