Screening For Lung Cancer

Publication Date: July 13, 2021
Last Updated: October 30, 2023

Recommendations

For asymptomatic individuals age 55 to 77 who have smoked 30 pack years or more and either continue to smoke or have quit within the past 15 years, we recommend that annual screening with low-dose CT should be offered. (S-M)
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For asymptomatic individuals who do not meet the smoking and/or age criteria in Recommendation #1, are age 50 to 80, have smoked 20 pack years or more and either continue to smoke or have quit within the past 15 years, we suggest that annual screening with low-dose CT should be offered. (W-M)
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For asymptomatic individuals who do not meet the smoking and/or age criteria in Recommendations #1 and 2 but are projected to have a high net benefit from lung cancer screening based on the results of validated clinical risk prediction calculations and life expectancy estimates, or based on life-year gained calculations, we suggest that annual screening with low-dose CT should be offered. (W-M)
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For individuals who have accumulated fewer than 20 pack years of smoking or are younger than age 50 or older than 80, or have quit smoking more than 15 years ago, and are not projected to have a high net benefit from lung cancer screening based on clinical risk prediction or life-year gained calculators, we recommend that low dose CT screening should not be performed. (S-M)
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For individuals with comorbidities that substantially limit their life expectancy and adversely influence their ability to tolerate the evaluation of screen detected findings, or tolerate treatment of an early stage screen detected lung cancer, we recommend that low-dose CT screening should not be performed. (S-L)
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We suggest that low-dose CT screening programs develop strategies to provide effective counseling and shared decision-making visits prior to the performance of the LDCT screening exam. (U-CBS)
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We suggest that low-dose CT screening programs develop strategies to determine whether patients have symptoms that suggest the presence of lung cancer, so that symptomatic patients do not enter screening programs but instead receive appropriate diagnostic testing, regardless of whether the symptomatic patient meets screening eligibility criteria. (U-CBS)
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We suggest 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. (W-L)
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We suggest that low-dose CT screening programs develop strategies to maximize compliance with annual screening exams. (U-CBS)
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We suggest that low-dose CT screening programs develop a comprehensive approach to lung nodule management, including multi-disciplinary expertise (Pulmonary, Radiology, Thoracic Surgery, Medical and Radiation Oncology), and algorithms for the management of small solid nodules, larger solid nodules, and sub-solid nodules. (U-CBS)
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We suggest that low-dose CT screening programs develop strategies to minimize overtreatment of potentially indolent lung cancers. (U-CBS)
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For current smokers undergoing low-dose CT screening, we recommend that screening programs provide evidence-based tobacco cessation treatment as recommended by the US Public Health Service. (S-L)
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We suggest that low-dose CT screening programs follow the ACR/STR protocols for performing low radiation dose chest CT scans. (U-CBS)
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We suggest that low-dose CT screening programs use a structured reporting system to report the exam results. (U-CBS)
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We suggest that low-dose CT screening programs develop strategies to guide the management of nonnodule findings. (U-CBS)
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We suggest that low-dose CT screening programs develop data collection and reporting tools capable of assisting with quality improvement initiatives and reporting to the current National Registry. (U-CBS)
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Recommendation Grading

Overview

Title

Screening For Lung Cancer

Authoring Organization

American College of Chest Physicians

Publication Month/Year

July 13, 2021

Last Updated Month/Year

January 22, 2024

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Low-dose chest CT screening for lung cancer has become a standard of care in the United States in the past few years, in large part due to the results of the National Lung Screening Trial. The benefit and harms of low-dose chest CT screening differ in both frequency and magnitude. The translation of a favorable balance of benefit and harms into practice can be difficult. Here, we update the evidence base for the benefit, harms, and implementation of low radiation dose chest CT screening. We use the updated evidence base to provide recommendations where the evidence allows, and statements based on experience and expert consensus where it does not.

Target Patient Population

Patients with risk of lung cancer

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Long term care, Outpatient, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening

Diseases/Conditions (MeSH)

D008175 - Lung Neoplasms, D000076862 - Diagnostic Screening Programs, D003952 - Diagnostic Imaging

Keywords

lung cancer, screening, CT imaging, cancer screening

Source Citation

Mazzone PJ, Silvestri GA, Souter LH, Caverly TJ, Kanne JP, Katki HA, Wiener RS, Detterbeck FC. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160(5):e427-e494. doi: 10.1016/j.chest.2021.06.063. Epub 2021 Jul 13. PMID: 34270968; PMCID: PMC8727886.

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
233
Literature Search Start Date
September 1, 2017
Literature Search End Date
June 1, 2019