What are recommendations for lung cancer screening?

Updated: Jul 15, 2021
  • Author: Winston W Tan, MD, FACP; Chief Editor: Nagla Abdel Karim, MD, PhD  more...
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Answer

Most of the guidelines recommend offering annual screening with low-dose, computed tomography (LDCT) scanning to patients aged 55 to 74 years who have at least a 30 pack-year smoking history and either continue to smoke or have quit within the past 15 years. [65, 46, 64, 66, 226]  

In March 2021, the USPSTF extended its screening recommendation to include persons aged 50 to 80 with at least a 20-pack-year smoking history. The USPSTF recommends discontinuing screening once 15 years have gone by since the patient stopped smoking, or if the patient develops a health problem that "substantially limits life expectancy or the ability or willingness to have curative lung surgery." [66]  

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. [226]

The NCCN extends screening to 77 years. 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.


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