16 New Guidelines for Lung Cancer Screening

There is new evidence-based guidance for the use of low-dose CT (LDCT) for lung cancer screening from the American College of Chest Physicians.

In an article published July 13 in CHEST, an expert panel from the College released 16 clinical recommendations based on a review of 75 studies. The new guidelines focus on the benefits, harms, and implementation of LDCT.

“The goal of these guidelines is to assist stakeholders with the development of high-quality screening programs and arm clinical providers with the information necessary to engage at-risk individuals in order to increase the number of screenings,” said lead author Peter Mazzone, M.D., MPH, FCCP. “Outlined in the recommendations is who should be screened and what that screening process should look like from the clinical side. For an individual patient, these guidelines highlight the importance of education to foster informed, value-based decisions about whether to be screened.”

Here is a summary of the 16 recommendations:

1. For asymptomatic patients between ages 55 and 77 who have smoked at least 30 pack years, continue to smoke, or have quit within the past 15 years, annual LDCT screening is recommended.
2. For asymptomatic individuals who don’t meet the smoking or age requirements from Recommendation 1 but are between ages 50 and 80 with at least 20 pack years, continued smoking, or cessation within the past 15 years, annual LDCT screening is recommended.
3. Offer LDCT screening to asymptomatic patients with don’t meet the smoking or age requirements from Recommendations 1 and 2, but who are projected to have high net benefit from screening based on results from a validated clinical risk prediction calculation and life expectancy estimates or life-year gained calculations.
4. For individuals with fewer than 20 pack years or who are younger than age 50 or older than age 80, have quit within the past 15 years, or who aren’t projected to have high net benefit based on the above-mentioned calculations, don’t perform LDCT.
5. Patients with co-morbidities that substantially affect their life expectancy or adversely limit their ability to tolerate any findings from screenings or any treatment of early-stage disease should not undergo annual LDCT.
6. LDCT screening programs should have strategies in place to identify patients with symptoms of existing cancer to ensure these patients, regardless of whether they meet screening eligibility criteria, aren’t placed in screening protocols, but are tracked to receive appropriate diagnostic testing.
7. LDCT programs should include counseling and shared decision-making visits prior to the LDCT exam itself.
8. Establish what constitutes a positive LDCT exam based on the size of the solid or part-solid lung nodules detected. The panel recommended a threshold that is either 4 mm, 5 mm, of 6 mm in diameter.
9. LDCT programs should develop and implement strategies to maximize annual screening compliance and evaluation of detected findings.
10. LDCT screening programs should create a multi-disciplinary lung nodule management approach, including radiology, pulmonary, thoracic surgery, and medical and radiation oncology, as well as algorithms for managing small and large solid nodules and sub-solid nodules.
11. LDCT programs should have strategies in place that minimize over-treatment of potentially indolent lung cancers.
12. For current smokers undergoing LDCT screening, programs should provide evidence-based tobacco cessation treatment.
13. LDCT programs should follow American College of Radiology and Society of Thoracic Radiology protocols when performing chest CT scans.
14. LDCT programs should use structured reporting for providing exam results.
15. LDCT programs should develop strategies for guiding the management of non-lung nodule findings.
16. LDCT programs should create data collection and reporting tools that can help with quality improvement initiatives and reporting to the current National Registry.

As a supplement to these published recommendations, CHEST and Thomas Jefferson University are offering a course dedicated to helping patients decide whether to undergo screening.

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