What are the guidelines for non–small cell lung cancer (NSCLC) screening?

Updated: Jun 05, 2020
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

The NCCN guidelines recommend beginning screening at age 50 and lowering the threshold to at least a 20 pack-year smoking history when a patient has one of the following additional risk factors [64] :

  • Radon exposure (documented sustained and substantially elevated)
  • Occupational exposure to carcinogens (eg, silica, cadmium, asbestos, arsenic, beryllium, chromium, diesel fumes, nickel, coal smoke, soot)
  • Cancer history (eg, lymphomas, head and neck cancer)
  • Family history of lung cancer in first-degree relatives
  • Disease history (chronic obstructive pulmonary disease [COPD] or pulmonary fibrosis)

The USPSTF recommends discontinuing screening in patients who either have not smoked for 15 years or who have developed a health condition that will substantially limit their life expectancy, the feasibility of curative lung surgery, or their willingness to undergo such surgery. [66]

Using data from the National Health Interview Survey, Cheung et al estimated the number of US smokers eligible for screening on the basis of either USPSTF criteria or the Lung Cancer Risk Assessment Tool and the number of lung cancer deaths preventable with each method. They determined that with risk-based screening, more people would be screened and more deaths prevented. In 2015, risk-based screening would have prevented 5000 more lung cancer deaths than USPSTF-based screening. [67]  However, an analysis by Kumar et al concluded that risk-based screening provides only attenuated and modest benefits with respect to life-years, quality-adjusted life-years, and cost-effectiveness. [68]

A randomized trial designed to assess the value of prolonged lung cancer screening beyond 5 years found LDCT screening benefit improved beyond the 5th year of screening, with a 58% reduced risk of lung cancer mortality (HR 0.42; 95% CI 0.22–0.79), and 32% reduction of overall mortality (HR 0.68; 95% CI 0.49–0.94). [69]


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