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Screening not recommended in asymptomatic pts <50 yo, regardless of smoking hx. Encourage tobacco cessation if relevant 1-3- Age 50 yo is recommended threshold to start screening in selected current/former smokers per USPSTF,4 NCCN,3 & AATS;5 however, ACS,2 ACCP,1 ALA6 suggest start age of 55 yo
Footnotes 1 ACCP 2018. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2018. Apr;153(4):954-985. PubMed abstract | Full-text PDF
Risk-prediction calculators. Calculators reflect variables that contribute to ↑all-cause mortality & ↑screening-related morbidity. Evidence doesn’t support screening based on risk-prediction calculator scores. However, for pts not meeting age or smoking criteria for routine screening who are @ high lung CA risk per clinical risk-prediction calculators (eg, 1.51% over 6y on PLCOm2012 calculator), low-dose CT screening could be considered in pts healthy enough to benefit from screening.
2 ACS 2013. Wender R, et al. American Cancer Society Lung Cancer Screening Guidelines. CA Cancer J Clin. Mar-Apr 2013;63(2):107-17. PubMed abstract | Full-text PDF
3 NCCN 2020. Lung Cancer Screening. NCCN Guidelines Version 1.2020. Last update: 5/14/19. Accessed online 9/9/20
4 USPSTF 2021. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. March 9, 2021. Accessed online 3/9/21
5 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;144:33-8 Full-text PDF
6 ALA 2020. American Lung Association. Should My Patient Be Screened for Lung Cancer? Last updated 5/4/20. Accessed online 9/9/20
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Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant 1-3- Select pts for annual screen: current/recent smoker (quit w/in past 15y) w/ ≥20 pk-yr hx, per USPSTF;4 however, AATS, NCCN specify only if such pts have ↑risk (eg, COPD, environment/occupation exposure, genetic risks, etc),3,5 & AATS includes former smokers regardless of years since quitting.5 ACCP doesn’t recommend routine screening <55 yo even if prediction calculator shows ↑risk (though could consider in some pts healthy enough to benefit).1 ACS,2 ALA6 suggest start age of 55 yo
- Discuss risks/benefits, including consequence of false(+), ongoing annual screening; employ shared decision-making before ordering screen2,5,6
- D/C screening if ↓ life expectancy due to health problem1,2,4 or pt unable/unwilling to undergo curative tx3,4
- Don’t use CXR alone as screen2,3,5,6
Footnotes 1 ACCP 2018. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2018. Apr;153(4):954-985. PubMed abstract | Full-text PDF
2 ACS 2013. Wender R, et al. American Cancer Society Lung Cancer Screening Guidelines. CA Cancer J Clin. Mar-Apr 2013;63(2):107-17. PubMed abstract | Full-text PDF
3 NCCN 2020. Lung Cancer Screening. NCCN Guidelines Version 1.2020. Last update: 5/14/19. Accessed online 9/9/20
Additional risk (ie, >1.3% risk of lung CA in next 6y): Factors include personal hx of CA (previous lung, head/neck, bladder, lymphoma), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA in 1st-degree relative.
Tammemagi risk calculator can also be used to identify pts at higher risk.
( 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)
4 USPSTF 2021. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. March 9, 2021. Accessed online 3/9/21
5 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;144:33-8 Full-text PDF
Additional risk (ie, >5% risk of lung CA in next 5y): COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, any hx of CA or thoracic radiation, genetic risk or FHx lung CA.
6 ALA 2020. American Lung Association. Should My Patient Be Screened for Lung Cancer? Last updated 5/4/20. Accessed online 9/9/20
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Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant 1-3- Select pts for annual screen: current/recent smoker (quit w/in past 15y) w/ ≥20 pk-yr hx, per USPSTF4 or ≥30 pk-yr per AATS,5 ACS,2 ACCP,1 ALA,6 NCCN3; AATS, NCCN specify screening in pts w/ ≥20 pk-yr hx only if such pts have additional risk factors (eg, COPD, environment/occupation exposure, genetic risks, etc),3,5 & AATS includes former smokers regardless of years since quitting5
- Discuss risks/benefits, consequences of false(+), continued annual screening; employ shared decision-making before ordering screen2,5,6
- D/C screening if ↓ life expectancy due to health problem1,2,4 or pt unable/unwilling to undergo curative tx3,4
- Don’t use CXR alone as screen2,3,5,6
Footnotes 1 ACCP 2018. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2018. Apr;153(4):954-985. PubMed abstract | Full-text PDF
2 ACS 2013. Wender R, et al. American Cancer Society Lung Cancer Screening Guidelines. CA Cancer J Clin. Mar-Apr 2013;63(2):107-17. PubMed abstract | Full-text PDF
3 NCCN 2020. Lung Cancer Screening. NCCN Guidelines Version 1.2020. Last update: 5/14/19. Accessed online 9/9/20
Additional risk factors include personal hx of CA (previous lung, head/neck, bladder, lymphoma), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA.
Tammemagi risk calculator can also be used to identify pts at higher risk.
( 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)
4 USPSTF 2021. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. March 9, 2021. Accessed online 3/9/21
5 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;144:33-8 Full-text PDF
Additional risk (ie, >5% risk of lung CA in next 5y): COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, any hx of CA or thoracic radiation, genetic risk or FHx lung CA
6 ALA 2020. American Lung Association. Should My Patient Be Screened for Lung Cancer? Last updated 5/4/20. Accessed online 9/9/20
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Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant 1-3- Select pts for annual screen: current/recent smoker (quit w/in past 15y) w/ ≥20 pk-yr hx, per USPSTF4 or ≥30 pk-yr per AATS,5 ACCP,1 ALA,6 NCCN;3 AATS, NCCN specify screening in pts w/ ≥20 pk-yr hx only if such pts have additional risk factors (eg, COPD, environment/occupation exposure, genetic risks, etc),3,5 & AATS includes former smokers regardless of years since quitting.5 ACS considers risk/benefit of screening in >74 yo uncertain2
- Discuss risks/benefits, consequences of false(+), continued annual screening; employ shared decision-making before ordering screen2,5,6
- D/C screening if ↓ life expectancy due to health problem1,2,4 or pt unable/unwilling to undergo curative tx3,4
- Don’t use CXR alone as screen2,3,5,6
Footnotes 1 ACCP 2018. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2018. Apr;153(4):954-985. PubMed abstract | Full-text PDF
2 ACS 2013. Wender R, et al. American Cancer Society Lung Cancer Screening Guidelines. CA Cancer J Clin. Mar-Apr 2013;63(2):107-17. PubMed abstract | Full-text PDF
3 NCCN 2020. Lung Cancer Screening. NCCN Guidelines Version 1.2020. Last update: 5/14/19. Accessed online 9/9/20
Additional risk factors include personal hx of CA (previous lung, head/neck, bladder, lymphoma), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA.
Tammemagi risk calculator can also be used to identify pts at higher risk.
( 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)
4 USPSTF 2021. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. March 9, 2021. Accessed online 3/9/21
5 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;144:33-8 Full-text PDF
Additional risk (ie, >5% risk of lung CA in next 5y): COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, any hx of CA or thoracic radiation, genetic risk or FHx lung CA
6 ALA 2020. American Lung Association. Should My Patient Be Screened for Lung Cancer? Last updated 5/4/20. Accessed online 9/9/20
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Use annual low-dose CT to screen certain current/former smokers. Encourage tobacco cessation if relevant 1-3- Select pts for annual screen: Current/recent smoker (quit w/in past 15y) w/ ≥20 pk-yr hx per USPSTF4 or ≥30 pk-yr per AATS,5 ALA;6 AATS, NCCN specify screening in pts w/ ≥20 pk-yr hx only if such pts have additional risk factors (eg, COPD, environment/occupation exposure, genetic risks, etc);3,5 AATS includes former smokers regardless of years since quitting5 & recommends d/c’ing screening @ 79 yo.5 ACS2 doesn’t recommend screening at this age, nor does ACCP, even if prediction calculator shows ↑risk (though could consider in some pts healthy enough to benefit)1
- Discuss risks/benefits, consequences of false(+), continued annual screening; employ shared decision-making before ordering screen.2,5,6 Consider insurance benefits: Medicare coverage doesn’t extend past 77 yo6
- D/C screening if ↓ life expectancy due to health problem1,2,4 or pt unable/unwilling to undergo curative tx3,4
- Don’t use CXR alone as screen2,3,5,6
Footnotes 1 ACCP 2018. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2018. Apr;153(4):954-985. PubMed abstract | Full-text PDF
Risk-prediction calculators. Calculators reflect variables that contribute to ↑all-cause mortality & ↑screening-related morbidity. Evidence doesn’t support screening based on risk-prediction calculator scores. However, for pts not meeting age or smoking criteria for routine screening who are @ high lung CA risk per clinical risk-prediction calculators (eg, 1.51% over 6y on PLCOm2012 calculator), low-dose CT screening could be considered in pts healthy enough to benefit from screening.
2 ACS 2013. Wender R, et al. American Cancer Society Lung Cancer Screening Guidelines. CA Cancer J Clin. Mar-Apr 2013;63(2):107-17. PubMed abstract | Full-text PDF
3 NCCN 2020. Lung Cancer Screening. NCCN Guidelines Version 1.2020. Last update: 5/14/19. Accessed online 9/9/20
Additional risk factors include personal hx of CA (previous lung, head/neck, bladder, lymphoma), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA.
Tammemagi risk calculator can also be used to identify pts at higher risk.
( 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)
4 USPSTF 2021. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. March 9, 2021. Accessed online 3/9/21
5 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;144:33-8. Full-text PDF
Additional risk (ie, >5% risk of lung CA in next 5y): COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, any hx of CA or thoracic radiation, genetic risk or FHx lung CA.
6 ALA 2020. American Lung Association. Should My Patient Be Screened for Lung Cancer? Last updated 5/4/20. Accessed online 9/9/20
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Screening generally not recommended 1-3 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 1,4,5- USPSTF, ACS, ALA: Screening not recommended1-3
- NCCN: Screening current/former smoker (quit w/in past 15y) w/ ≥20 pk-yr hx reasonable if all are true: 1) additional risk factors5 present; 2) pt willing & able to tolerate curative tx; 3) life expectancy not ↓ by serious comorbidities5
- AATS: Unclear advantages, inadequate data on screening >79 yo, given competing mortality causes; could consider screening select pts if preserved functional status6
- ACCP: Doesn’t recommend routine screening >77 yo even if prediction calculator shows ↑risk (though could consider in some pts healthy enough to benefit)4
- D/C screening if ↓ life expectancy due to health problem1,2,4 or pt unable/unwilling to undergo curative tx2,5
- Don’t use CXR alone as screening1,3,5,6
Footnotes 1 ACS 2013. Wender R, et al. American Cancer Society Lung Cancer Screening Guidelines. CA Cancer J Clin. Mar-Apr 2013;63(2):107-17. PubMed abstract | Full-text PDF
2 USPSTF 2021. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. March 9, 2021. Accessed online 3/9/21
3 ALA 2020. American Lung Association. Should My Patient Be Screened for Lung Cancer? Last updated 5/4/20. Accessed online 9/9/20
4 ACCP 2018. Mazzone PJ, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2018. Apr;153(4):954-985. PubMed abstract | Full-text PDF
Risk-prediction calculators. Calculators reflect variables that contribute to ↑all-cause mortality & ↑screening-related morbidity. Evidence doesn’t support screening based on risk-prediction calculator scores. However, for pts not meeting age or smoking criteria for routine screening who are @ high lung CA risk per clinical risk-prediction calculators (eg, 1.51% over 6y on PLCOm2012 calculator), low-dose CT screening could be considered in pts healthy enough to benefit from screening.
5 NCCN 2020. Lung Cancer Screening. NCCN Guidelines Version 1.2020. Last update: 5/14/19. Accessed online 9/9/20
Additional risk factors include personal hx of CA (previous lung, head/neck, bladder, lymphoma), COPD, pulm fibrosis, radon exposure, occupational carcinogen exposure, FHx lung CA.
Tammemagi risk calculator can also be used to identify pts at higher risk.
( 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)
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;144:33-8. Full-text PDF
Additional risk (ie, >5% risk of lung CA in next 5y): COPD w/ FEV1 ≤70%, environmental/occupational carcinogen exposure, any hx of CA or thoracic radiation, genetic risk or FHx lung CA
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