USPSTF,19 2014
USA; Summary26 | “The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation)” Page 330 |
ACCP,20 2013
USA | “For smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years, we suggest that annual screening with LDCT should be offered over both annual screening with CXR or no screening, but only in settings that can deliver the comprehensive care provided to NLST participants (Grade 2B).” page e85s
“For individuals who have accumulated fewer than 30 pack-years of smoking or are either younger than age 55 or older than 74, or individuals who quit smoking more than 15 years ago, and for individuals with severe comorbidities that would preclude potentially curative treatment and/or limit life expectancy, we suggest that CT screening should not be performed (Grade 2C).” page e85s |
ACS,21 2013,
USA | “Clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about lung cancer screening with patients aged 55 years to 74 years who have at least a 30-pack-year smoking history, currently smoke, or have quit within the past 15 years, and who are in relatively good health. Core elements of this discussion should include the following benefits, uncertainties, and harms of screening:
Benefit: Screening with LDCT has been shown to substantially reduce the risk of dying from lung cancer. Limitations: LDCT will not detect all lung cancers or all lung cancers early, and not all patients who have a lung cancer detected by LDCT will avoid death from lung cancer. Harms: There is a significant chance of a false-positive result, which will require additional periodic testing and, in some instances, an invasive procedure to determine whether or not an abnormality is lung cancer or some non-lung cancer related incidental finding. Fewer than 1 in 1000 patients with a false-positive result experience a major complication resulting from a diagnostic workup. Death within 60 days of a diagnostic evaluation has been documented, but is rare and most often occurs in patients with lung cancer. Smoking cessation counseling constitutes a high priority for clinical attention for patients who are currently smoking. Current smokers should be informed of their continuing risk of lung cancer, and referred to smoking cessation programs. Screening should not be viewed as an alternative to smoking cessation. Eligible patients should make the screening decision together with their health care provider. Helping individuals to clarify their personal values can facilitate effective decision-making: Individuals who value the opportunity to reduce their risk of dying from lung cancer and who are willing to accept the risks and costs associated with having a LDCT and the relatively high likelihood of the need for further tests, even tests that have the rare but real risk of complications and death, may opt to be screened with LDCT every year. Individuals who place greater value on avoiding testing that carries a high risk of false-positive results and a small risk of complications, and who understand and accept that they are at a much higher risk of death from lung cancer than from screening complications, may opt not to be screened with LDCT. Clinicians should not discuss lung cancer screening with LDCT with patients who do not meet the above criteria. If lung cancer screening is requested, these patients should be informed that at this time, there is too much uncertainty regarding the balance of benefits and harms for individuals at younger or older ages and/ or with less lifetime exposure to tobacco smoke and/or with sufficiently severe lung damage to require oxygen (or other health-related NLST exclusion criteria), and therefore screening is not recommended. Adults who choose to be screened should follow the NLST protocol of annual LDCT screening until they reach age 74 years. CXR should not be used for cancer screening. Wherever possible, adults who choose to undergo lung screening preferably should enter an organized screening program at an institution with expertise in LDCT screening, with access to a multidisciplinary team skilled in the evaluation, diagnosis, and treatment of abnormal lung lesions. If an organized, experienced screening program is not accessible, but the patient strongly wishes to be screened, they should be referred to a center that performs a reasonably high volume of lung CT scans, diagnostic tests, and lung cancer surgeries. If such a setting is not available and the patient is not willing or able to travel to such a setting, the risks of cancer screening may be substantially higher than the observed risks associated with screening in the NLST, and screening is not recommended. Referring physicians should help their patients identify appropriate settings with this expertise.” Page 11, 12 of 18
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Cancer Care Ontario,23 2013,
Canada; Summary24 | Recommendation 1: “Screening for lung cancer with LDCT is recommended in high-risk populations defined as persons 55 to 74 years of age with a minimum smoking history of ≥30 pack-years who currently smoke or have quit within the past 15 years and are disease free at the time of screening.” Page 6
Recommendation 2: Positive Result and Follow-up
“□ Screening modality: Screening for lung cancer should be done using an LDCT multi-detector scanner with the following parameters: 120 to 140 peak kilovoltage (kVp), 20 to 60 milliampere seconds (mAs), with an average effective dose ≤1.5 millisieverts (mSv).
□ Collimation should be ≤2.5 mm.
□ Definition of a positive result: A nodule size of ≥5 mm found on LDCT indicates a positive result and warrants a 3-month follow-up CT. Nodules ≥15 mm should undergo immediate further diagnostic procedures to rule out definitive malignancy.
□ Appropriate follow-up of a positive result: Follow-up CT of a nodule should be done at 3 months as a limited LDCT scan (i.e., only a slab covering the nodule will be scanned, not the entire chest). The Lung Cancer Diagnosis Pathway should be consulted for guidance on clinical work-up.” Page 7
Recommendation 3: “Persons at high risk for lung cancer should commence screening with an initial LDCT scan followed by annual screens for 2 consecutive years, and then once every 2 years after each negative (-ve) scan.” Page 9 |
AATS,22 2012,
USA | “1. Annual lung cancer screening with LDCT for smokers and former smokers with 30 pack-year history of smoking from ages 55 to 79 y.
2. Long-term lung cancer survivors should have annual LDCT to detect second primary lung cancer until the age of 79 y.
3. Annual lung cancer screening with LDCT for smokers and former smokers aged 50 to 79 y with a 20 pack-year history of smoking and additional comorbidity that produces a cumulative risk of developing lung cancer of ≥ 5% over the following 5 y.
4. Lung cancer screening and successful treatment of early-stage lung cancer by a subspecialty qualified team, including thoracic surgeons, thoracic radiologists, pulmonologists, oncologists, and pathologists.
5. Develop a web-based application for patient self-risk assessment.
6. Continue AATS engagement with other specialty societies to develop and refine future screening guidelines.” Page 27 |
