What are recommendations for lung cancer screening?

Updated: Jun 05, 2020
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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The USPSTF extends the recommended age range to 80 years, while the NCCN extends screening to 77 years. [66, 64]  

The American Association for Thoracic Surgery (AATS) extends the recommended age range to 79 years and also recommends annual screening starting at age 50 for patients who have a 20 pack-year smoking history and additional comorbid conditions that produce a cumulative risk for cancer of at least 5% over the next 5 years. Additionally, it recommends annual screening in long-term cancer survivors aged 55 to 79 years. [219]

The NCCN guidelines also recommend screening starting at age 50 in patients with at least a 20 pack-year smoking history and one or more of the following risk factors [64] :

  • Radon exposure (documented sustained and substantial)

  • Occupational exposure to lung carcinogens (eg, silica, cadmium, asbestos, arsenic, beryllium, chromium, diesel fumes, nickel, coal smoke, soot)

  • Cancer history (lung cancer, lymphomas, cancers of the head and neck, or smoking-related cancers)

  • Family history of lung cancer in first-degree relatives 

  • Chronic obstructive pulmonary disease or pulmonary fibrosis

The groups also agree that the shared decision making is required and should include a discussion of benefits and risks.

None of the guidelines recommend screening asymptomatic patients for lung cancer with chest radiograph or sputum cytology.

See Small Cell Lung Cancer: Beating the Spread, a Critical Images slideshow, to help identify the key clinical and biologic characteristics of small cell lung cancer, the staging criteria, and the common sites of spread.

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