What is the recommendation for computed tomography (CT) of the lung for smokers over 50 years old with a history of smoking?

From the Guidelines

Annual low-dose computed tomography (LDCT) screening for lung cancer is recommended for current smokers and former smokers aged 55-80 who have a 30 pack-year smoking history and either continue to smoke or have quit within the past 15 years. This recommendation is based on the findings of the National Lung Screening Trial and is supported by the United States Preventive Services Task Force 1. The screening involves a quick, non-invasive CT scan that uses lower radiation doses than standard CT scans. The purpose is to detect lung cancer at earlier, more treatable stages, as symptoms typically don't appear until the disease is advanced.

Key Considerations

• The American Cancer Society also recommends LDCT screening for high-risk patients who are in relatively good health and meet the NLST criteria 1.
• The US Preventive Services Task Force recommends annual screening for lung cancer with LDCT in persons who are at high risk based on age and cumulative tobacco smoke exposure 1.
• Patients should discuss their individual risk factors with their healthcare provider to determine if screening is appropriate for them, as smoking history, family history, and other lung conditions may influence this decision.
• Insurance coverage, including Medicare, is generally available for those meeting these criteria.

Benefits and Risks

• Annual LDCT screening can reduce lung cancer mortality by 20-25% in high-risk individuals.
• However, screening also carries potential harms, including false positive findings, overdiagnosis, and unnecessary invasive testing.
• Effective screening requires an appreciation that screening should be limited to individuals at high risk of death from lung cancer.

Implementation

• Screening should be offered only in clinical settings similar to those in the trial.
• All adults who receive screening should enter an organized screening program that has experience in LDCT.
• Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers.

From the Research

Recommendation for CT of Lung for Smokers over 50

• The US Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (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.
• The recommendation is based on a systematic review of the accuracy of screening for lung cancer with LDCT and the benefits and harms of screening for lung cancer 2.
• The USPSTF concludes with moderate certainty that 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 2.

Benefits and Harms of Screening

• Screening with LDCT can reduce lung cancer mortality, but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental findings, increases in distress, and, rarely, radiation-induced cancers 3.
• The National Lung Screening Trial (NLST) found a reduction in lung cancer mortality with 3 rounds of annual LDCT screening compared with chest radiograph for high-risk current and former smokers aged 55 to 74 years 3.
• The Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial found a reduction in lung cancer mortality with 4 rounds of LDCT screening with increasing intervals compared with no screening for high-risk current and former smokers aged 50 to 74 years 3.

Implementation of Screening

• Successful implementation of and accessibility to LDCT lung cancer screening are dependent on many factors, including population selection, recruitment strategy, computed tomography screening frequency, lung-nodule management, participant compliance, and cost effectiveness 4.
• Evidence shows that through the appropriate use of risk-prediction models and a more personalized approach to screening, efficacy could be improved 4.
• Extending the screening interval for low-risk individuals to reduce costs and associated harms is a possibility, and through the use of volumetric-based measurement and follow-up, false positive results can be greatly reduced 4.