Lung Cancer Screening

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Key points

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    Lung cancer screening with low radiation dose chest computed tomography scans decreases lung cancer mortality.

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    It is important to balance the benefits of screening with the potential harms, including evaluation of false-positive results, complications from diagnostic testing, overdiagnosis, and the impact of radiation exposure.

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    Integration of smoking cessation interventions may augment the benefits of lung cancer screening.

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    Widespread implementation and access to high-quality lung cancer screening

Evidence that supports lung cancer screening

Early lung cancer screening trials evaluated chest radiographs (CXR) and sputum cytology as screening tests. Despite finding improved survival for those with screen detected lung cancer, the trials failed to demonstrate a reduction in lung cancer specific mortality.5, 6, 7 Improvements in computed tomography (CT) scanning techniques, leading to increased sensitivity to detect small lung cancers, raised the interest to evaluate LDCT scans as a lung cancer screening tool.

The Early Lung Cancer

Potential harms

An estimated 8.4 million individuals met the eligibility criteria for lung cancer screening as proposed by the USPSTF in 2013.17 The potential eligible population was older, had a higher proportion of current smokers, and had more comorbidities than the NLST population. This finding highlights the importance of balancing the benefits and potential harms of LDCT screening in clinical practice.18 A clear understanding of the potential harms related to LDCT screening should be considered. Some of

Implementation of screening programs

In December 2013, the USPSTF released a grade B recommendation to screen high-risk individuals, defined as those age 55 to 80 who have a minimum smoking history of 30 pack-years and who currently smoke or have quit within the past 15 years.3 The Affordable Care Act (ACA) required that commercial insurance plans participating in the health care exchange cover screening services that receive a grade B recommendation from the USPSTF, guaranteeing coverage to insured patients younger than 65 years

Future directions

Many lessons have been learned since the early stages of implementation of lung cancer screening programs. Likewise, many questions and challenges remain. The major concerns are related to how to improve patient selection for screening, how to minimize the potential harms, and how to facilitate implementation and access to screening programs. Eligibility based on age and smoking history has the advantage of its simplicity, but risk-based strategies using validated models may be able to expand

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