A guideline and expert panel report on screening for lung cancer was recently released by CHEST.
A panel of experts developed 12 questions to address the benefit and harms of low-dose CT screening, as well as key areas of screening program implementation. After a systematic literature review identified 59 studies, they issued graded recommendations and ungraded consensus-based statements. The guideline and report were published online by CHEST on Jan. 25.
The graded recommendations are as follows:
- 1. For asymptomatic smokers and former smokers ages 55 to 77 years who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years, the panel suggests that annual screening with low-dose CT should be offered. (Weak recommendation, moderate-quality evidence)
- 2. For asymptomatic smokers and former smokers who do not meet the smoking and age criteria in Recommendation 1 but who are deemed to be at high risk of having/developing lung cancer based on clinical risk prediction calculators, the panel suggests that low-dose CT screening should not be routinely performed. (Weak recommendation, low-quality evidence)
- 3. For individuals who have accumulated fewer than 30 pack-years of smoking or who are younger than age 55 years or older than age 77 years, or who have quit smoking more than 15 years ago, and do not have a high risk of having/developing lung cancer based on clinical risk prediction calculators, the panel recommends that low-dose CT screening should not be performed. (Strong recommendation, moderate-quality evidence)
- 4. For individuals with comorbidities that adversely influence their ability to tolerate the evaluation of screen-detected findings, or tolerate treatment of an early stage screen-detected lung cancer, or that substantially limit their life expectancy, the panel recommends that low-dose CT screening should not be performed. (Strong recommendation, low-quality evidence)
- 5. The panel suggests that screening programs define what constitutes a positive test on the low-dose CT based on the size of a detected solid or part-solid lung nodule, with a threshold for a positive test that is either 4 mm, 5 mm, or 6 mm in diameter. (Weak recommendation, low-quality evidence)
- 6. For current smokers undergoing low-dose CT screening, the panel recommends that screening programs provide evidence-based tobacco cessation treatment as recommended by the U.S. Public Health Service. (Strong recommendation, low-quality evidence)
The consensus-based statements suggest that screening programs develop strategies to provide diagnostic testing rather than screening to symptomatic patients, provide effective counseling and shared decision-making visits prior to screening, maximize adherence to annual screening exams, minimize overtreatment of potentially indolent lung cancers, and guide the management of non-nodule findings. Screening programs are also advised to develop a comprehensive approach to lung nodule management, follow American College of Radiology/Society of Thoracic Radiology protocols, use a structured reporting system to report exam results, and develop data collection and reporting tools to assist with quality improvement initiatives and reporting to the current National Registry.