Lung Cancer—Clinician FAQ

Recommendations

  1. For adults aged 55–74 years with at least a 30 pack-year smoking history who currently smoke or quit less than 15 years ago, we recommend annual screening with low-dose computed tomography (LDCT) up to three consecutive times. Weak recommendation
  2. For adults aged 18–54 and 75+, regardless of smoking history or other risk factors, we recommend not screening for lung cancer with LDCT. Strong recommendation
  3. For adults aged 18 years and older, we recommend not screening for lung cancer with chest x-ray with or without sputum cytology. Strong recommendation

These recommendations apply to asymptomatic persons who meet the screening criteria; they do not apply to persons who have a history of lung cancer or are suspected of having lung cancer.

1. How should I implement a weak recommendation to screen with LDCT?

  • A weak recommendation implies that you should have a discussion with your patients about the benefits and harms of screening for lung cancer with LDCT (including false positives, side effects of invasive follow-up testing, and overdiagnosis).
  • Help them make a screening decision that is consistent with their values and preferences.

2. Why should I not screen with LDCT in patients who do not meet the age or smoking history criteria specified above?

  • There is no evidence showing that there are benefits of screening those who do not meet the recommended age range and smoking history criteria.

3. Why should I not screen using chest x-ray?

  • There is no evidence showing that screening for lung cancer with chest x-ray (with or without sputum cytology) improves patient-important outcomes, but there are known harms, including false positives, side effects of invasive follow-up testing (e.g., bronchoscopy, needle biopsy, thoracotomy, and thoracoscopy) and overdiagnosis.

4. Why screen annually for three years in a row?

  • It is possible that longer or more intensive screening might yield additional benefits, but there is not strong evidence (from an RCT) to support such a recommendation.

5. What should I do if LDCT is not available in my area?

  • Refer to a centre where LDCT scans and expertise in early diagnosis and treatment are available.
  • In all cases and at any age, smoking cessation is a recommended course of action.

Screening 1000 eligible people with LDCT vs. chest x-ray

  • 231 more people receive a positive test result
  • 4–5 fewer late-stage lung cancers are found
  • 8–9 more early-stage lung cancers are found
  • 3 more people are diagnosed with lung cancer
  • 3 fewer people die from lung cancer

Because of the potential for screening-related harms, LDCT and subsequent management should ONLY be carried out in health care settings with expertise in early diagnosis and treatment of lung cancer.

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