What are the imaging guidelines for lung cancer staging?

Updated: Jan 28, 2019
  • Author: Omar Lababede, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Guidelines on lung cancer screening have been issued by the following organizations:

  • American Cancer Society (ACS)
  • American College of Chest Physicians (ACCP)
  • National Comprehensive Cancer Network (NCCN)
  • U.S. Preventive Services Task Force (USPSTF)

The guidelines are in agreement that annual screening with low-dose, computed tomography (LDCT) scanning should be offered to patients aged 55 to 74 years and who have at least a 30 pack-year smoking history and either continue to smoke or have quit within the past 15 years. The USPSTF extends the recommended age range to 80 years, while the NCCN notes the existence of uncertainty about the upper age limit for screening and advises that screening beyond age 74 years may be considered as long as the patient's functional status and comorbidity allow consideration for curative intent therapy. [2, 3, 4, 5]

In addition, the NCCN guidelines recommend considering 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 [4] :

  • 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

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