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Screening not recommended in asymptomatic pts <50 yo, regardless of smoking hx. Encourage tobacco cessation if relevant. 1-4- Age 50 yo is recommended threshold to start screening in selected current/former smokers.1-6
- Offer low-dose CT screening to asymptomatic pts not meeting age or smoking criteria for screening who are projected to have a high net benefit from screening according to calculated thresholds (e.g., ≥2.6% over 6y on PLCOm2012 calculator).1
◦ Risk-prediction calculators.1 Calculators reflect variables that contribute to ↑all-cause mortality and ↑screening-related morbidity. Augmenting screening criteria w/ risk-prediction and life-year gained calculators leads to greater equity across race and sex in screening eligibility and net benefits of screening.
◦ Life-year gained calculators combine results of risk prediction and life expectancy estimates into 1 measure.1
Footnotes 1 ACCP 2021. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160(5):e427-e494. Full-text PDF
2 ACS 2023. Wolf AMD, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2021 Nov 1. Online ahead of print. Full-text article
3 NCCN 2023. National Comprehensive Cancer Network. Lung Cancer Screening (Version 2.2024). October 18, 2023. Accessed November 9, 2023
4 ALA 2023. Should My Patient Be Screened for Lung Cancer? American Lung Association. Accessed November 13, 2023
5 USPSTF 2021. US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 9;325(10):962-970. Full-text article
6 AATS 2012. Jaklitsch MT, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8. Full-text PDF
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Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant. 1-4- Select pts for annual screen: current/recent smoker (quit w/in past 15y1,4,5) w/ ≥20 pk-yr hx.1-5
◦ However, AATS6 specifies only if such pts have >5% risk of lung CA in next 5y (e.g., COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, hx of CA or thoracic radiation, genetic risk or FHx lung CA).
◦ ACS,2 NCCN,3 and AATS6 include former smokers regardless of years since quitting.
◦ ACCP1 weakly recommends annual screen for current/recent smokers 50-80 yo w/ ≥20 pk-yr hx and strongly recommends it for current/recent smokers 55-77 yo w/ ≥30 pk-yr hx. - Discuss risks/benefits, including consequences of false(+), ongoing annual screening; employ shared decision-making before ordering screen.2-4,6
- D/C screening if ↓life expectancy due to health condition1-3,5 or pt unable/unwilling to undergo curative tx.2,3,5
- Don’t use CXR alone as screen.2-4,6
- Offer low-dose CT screening to asymptomatic pts not meeting age or smoking criteria for screening who are projected to have a high net benefit from screening according to calculated thresholds (e.g., ≥2.6% over 6y on PLCOm2012 calculator).1
◦ Risk-prediction calculators.1 Calculators reflect variables that contribute to ↑all-cause mortality and ↑screening-related morbidity. Augmenting screening criteria w/ risk-prediction and life-year gained calculators leads to greater equity across race and sex in screening eligibility and net benefits of screening.
◦ Life-year gained calculators combine results of risk prediction and life expectancy estimates into 1 measure.1
◦ NCCN recommends using the Tammemagi risk calculator to identify pts at higher risk.3 (epocrates note: This calculator uses risk corrections based on pt race. The validity of such corrections has been called into question, may lead to over- or under-estimation of risk based on race). Lung Cancer Risk Estimation in Current and Past Smokers (6-year)
◦ Additional risk factors:3 personal hx of CA (previous lymphoma, head/neck, smoking related), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA in 1st-degree relative.
Footnotes 1 ACCP 2021. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160(5):e427-e494. Full-text PDF
2 ACS 2023. Wolf AMD, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2021 Nov 1. Online ahead of print. Full-text article
3 NCCN 2023. National Comprehensive Cancer Network. Lung Cancer Screening (Version 2.2024). October 18, 2023. Accessed November 9, 2023
4 ALA 2023. Should My Patient Be Screened for Lung Cancer? American Lung Association. Accessed November 13, 2023
5 USPSTF 2021. US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 9;325(10):962-970. Full-text article
6 AATS 2012. Jaklitsch MT, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8. Full-text PDF
-
Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant. 1-4- Select pts for annual screen: current/recent smoker (quit w/in past 15y1,4,5) w/ ≥20 pk-yr hx (per ACS,2 NCCN,3 ALA,4 USPSTF5) or ≥30 pk-yr hx (per ACCP,1 AATS6).
◦ AATS6 specifies screening in pts w/ ≥20 pk-yr hx only if such pts have additional risk factors (e.g., COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, hx of CA or thoracic radiation, genetic risk or FHx lung CA).
◦ ACS,2 NCCN,3 and AATS6 include former smokers regardless of years since quitting.
◦ ACCP1 strongly recommends annual screen w/ low-dose CT for current/recent smokers in this age group w/ ≥30 pk-yr hx and weakly recommends it for those w/ ≥20 pk-yr hx. - Discuss risks/benefits, including consequences of false(+), continued annual screening; employ shared decision-making before ordering screen.2-4,6
- D/C screening if ↓life expectancy due to health condition1-3,5 or pt unable/unwilling to undergo curative tx.2,3,5
- Don’t use CXR alone as screen.2-4,6
- Offer low-dose CT screening to asymptomatic pts not meeting age or smoking criteria for screening who are projected to have a high net benefit from screening according to calculated thresholds (e.g., ≥2.6% over 6y on PLCOm2012 calculator).1
◦ Risk-prediction calculators.1 Calculators reflect variables that contribute to ↑all-cause mortality and ↑screening-related morbidity. Augmenting screening criteria w/ risk-prediction and life-year gained calculators leads to greater equity across race and sex in screening eligibility and net benefits of screening.
◦ Life-year gained calculators combine results of risk prediction and life expectancy estimates into 1 measure.1
◦ NCCN recommends using the Tammemagi risk calculator to identify pts at higher risk.3 (epocrates note: This calculator uses risk corrections based on pt race. The validity of such corrections has been called into question, may lead to over- or under-estimation of risk based on race). Lung Cancer Risk Estimation in Current and Past Smokers (6-year)
◦ Additional risk factors:3 personal hx of CA (previous lymphoma, head/neck, smoking related), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA in 1st-degree relative.
Footnotes 1 ACCP 2021. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160(5):e427-e494. Full-text PDF
2 ACS 2023. Wolf AMD, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2021 Nov 1. Online ahead of print. Full-text article
3 NCCN 2023. National Comprehensive Cancer Network. Lung Cancer Screening (Version 2.2024). October 18, 2023. Accessed November 9, 2023
4 ALA 2023. Should My Patient Be Screened for Lung Cancer? American Lung Association. Accessed November 13, 2023
5 USPSTF 2021. US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 9;325(10):962-970. Full-text article
6 AATS 2012. Jaklitsch MT, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8. Full-text PDF
-
Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant. 1-4- Select pts for annual screen: current/recent smoker (quit w/in past 15y1,4,5) w/ ≥20 pk-yr hx (per ACS,2 NCCN,3 ALA,4 USPSTF5) or ≥30 pk-yr hx (per ACCP,1 AATS6).
◦ AATS6 specifies screening in pts w/ ≥20 pk-yr hx only if such pts have additional risk factors (e.g., COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, hx of CA or thoracic radiation, genetic risk or FHx lung CA).
◦ ACS,2 NCCN,3 and AATS6 include former smokers regardless of years since quitting.
◦ ACCP1 strongly recommends annual screen w/ low-dose CT for current/recent smokers in this age group w/ ≥30 pk-yr hx and weakly recommends it for those w/ ≥20 pk-yr hx. - Discuss risks/benefits, including consequences of false(+), continued annual screening; employ shared decision-making before ordering screen.2-4,6
- D/C screening if ↓life expectancy due to health condition1-3,5 or pt unable/unwilling to undergo curative tx.2,3,5
- Don’t use CXR alone as screen.2-4,6
- Offer low-dose CT screening to asymptomatic pts not meeting age or smoking criteria for screening who are projected to have a high net benefit from screening according to calculated thresholds (e.g., ≥2.6% over 6y on PLCOm2012 calculator).1
◦ Risk-prediction calculators.1 Calculators reflect variables that contribute to ↑all-cause mortality and ↑screening-related morbidity. Augmenting screening criteria w/ risk-prediction and life-year gained calculators leads to greater equity across race and sex in screening eligibility and net benefits of screening.
◦ Life-year gained calculators combine results of risk prediction and life expectancy estimates into 1 measure.1
◦ NCCN recommends using the Tammemagi risk calculator to identify pts at higher risk.3 (epocrates note: This calculator uses risk corrections based on pt race. The validity of such corrections has been called into question, may lead to over- or under-estimation of risk based on race). Lung Cancer Risk Estimation in Current and Past Smokers (6-year)
◦ Additional risk factors:3 personal hx of CA (previous lymphoma, head/neck, smoking related), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA in 1st-degree relative.
Footnotes 1 ACCP 2021. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160(5):e427-e494. Full-text PDF
2 ACS 2023. Wolf AMD, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2021 Nov 1. Online ahead of print. Full-text article
3 NCCN 2023. National Comprehensive Cancer Network. Lung Cancer Screening (Version 2.2024). October 18, 2023. Accessed November 9, 2023
4 ALA 2023. Should My Patient Be Screened for Lung Cancer? American Lung Association. Accessed November 13, 2023
5 USPSTF 2021. US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 9;325(10):962-970. Full-text article
6 AATS 2012. Jaklitsch MT, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8. Full-text PDF
-
Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant. 1-4- Select pts for annual screen: current/recent smoker (quit w/in past 15y1,4,5) w/ ≥20 pk-yr hx (per ACCP,1 ACS,2 NCCN,3 ALA,4 USPSTF5) or ≥30 pk-yr hx (per AATS6).
◦ AATS6 specifies screening in pts w/ ≥20 pk-yr hx only if such pts have additional risk factors (e.g., COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, hx of CA or thoracic radiation, genetic risk or FHx lung CA).
◦ ACS,2 NCCN,3 and AATS6 include former smokers regardless of years since quitting.
◦ AATS6 recommends d/c’ing screening @ 79 yo. - Discuss risks/benefits, including consequences of false(+), continued annual screening; employ shared decision-making before ordering screen.2-4,6 Consider insurance benefits: Medicare coverage doesn’t extend past 77 yo.4
- D/C screening if ↓life expectancy due to health condition1-3,5 or pt unable/unwilling to undergo curative tx.2,3,5
- Don’t use CXR alone as screen.2-4,6
- Offer low-dose CT screening to asymptomatic pts not meeting age or smoking criteria for screening who are projected to have a high net benefit from screening according to calculated thresholds (e.g., ≥2.6% over 6y on PLCOm2012 calculator).1
◦ Risk-prediction calculators.1 Calculators reflect variables that contribute to ↑all-cause mortality and ↑screening-related morbidity. Augmenting screening criteria w/ risk-prediction and life-year gained calculators leads to greater equity across race and sex in screening eligibility and net benefits of screening.
◦ Life-year gained calculators combine results of risk prediction and life expectancy estimates into 1 measure.1
◦ NCCN recommends using the Tammemagi risk calculator to identify pts at higher risk.3 (epocrates note: This calculator uses risk corrections based on pt race. The validity of such corrections has been called into question, may lead to over- or under-estimation of risk based on race). Lung Cancer Risk Estimation in Current and Past Smokers (6-year)
◦ Additional risk factors:3 personal hx of CA (previous lymphoma, head/neck, smoking related), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA in 1st-degree relative.
Footnotes 1 ACCP 2021. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160(5):e427-e494. Full-text PDF
2 ACS 2023. Wolf AMD, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2021 Nov 1. Online ahead of print. Full-text article
3 NCCN 2023. National Comprehensive Cancer Network. Lung Cancer Screening (Version 2.2024). October 18, 2023. Accessed November 9, 2023
4 ALA 2023. Should My Patient Be Screened for Lung Cancer? American Lung Association. Accessed November 13, 2023
5 USPSTF 2021. US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 9;325(10):962-970. Full-text article
6 AATS 2012. Jaklitsch MT, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8. Full-text PDF
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Screening generally not recommended 1-4 for asymptomatic pts, though various groups suggest considering factors for screening in select pts. Consider insurance benefits: Medicare coverage doesn’t extend past 77 yo. 3 Encourage tobacco cessation if relevant. 1,3-5- ACS, USPSTF, ALA, ACCP: Screening not recommended.1-4
- NCCN: Screening current/former smoker w/ ≥20 pk-yr hx reasonable if all are true: 1) additional risk factors present; 2) pt willing and able to tolerate curative tx; 3) life expectancy not ↓ by serious comorbidities.5
- AATS: Unclear advantages, inadequate data on screening >79 yo, given competing mortality causes; could consider screening select pts if preserved functional status.6
- D/C screening if ↓life expectancy due to health condition1,2,4,5 or pt unable/unwilling to undergo curative tx.1,2,5
- Don’t use CXR alone as screening.1,3,5,6
- Offer low-dose CT screening to asymptomatic pts not meeting age or smoking criteria for screening who are projected to have a high net benefit from screening according to calculated thresholds (e.g., ≥2.6% over 6y on PLCOm2012 calculator).4
◦ Risk-prediction calculators.4 Calculators reflect variables that contribute to ↑all-cause mortality and ↑screening-related morbidity. Augmenting screening criteria w/ risk-prediction and life-year gained calculators leads to greater equity across race and sex in screening eligibility and net benefits of screening.
◦ Life-year gained calculators combine results of risk prediction and life expectancy estimates into 1 measure.4
◦ NCCN recommends using the Tammemagi risk calculator to identify pts at higher risk.5 (epocrates note: This calculator uses risk corrections based on pt race. The validity of such corrections has been called into question, may lead to over- or under-estimation of risk based on race). Lung Cancer Risk Estimation in Current and Past Smokers (6-year)
◦ Additional risk factors:5 personal hx of CA (previous lymphoma, head/neck, smoking related), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA in 1st-degree relative.
Footnotes 1 ACS 2023. Wolf AMD, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2021 Nov 1. Online ahead of print. Full-text article
2 USPSTF 2021. US Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Mar 9;325(10):962-970. Full-text article
3 ALA 2023. Should My Patient Be Screened for Lung Cancer? American Lung Association. Accessed November 13, 2023
4 ACCP 2021. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021 Nov;160(5):e427-e494. Full-text PDF
5 NCCN 2023. National Comprehensive Cancer Network. Lung Cancer Screening (Version 2.2024). October 18, 2023. Accessed November 9, 2023
6 AATS 2012. Jaklitsch MT, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg. 2012 Jul;144(1):33-8. Full-text PDF
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