CHEST: New Lung Cancer Screening Guidelines

Further results from the guidelines will be shared at the CHEST Annual Meeting 2017
Further results from the guidelines will be shared at the CHEST Annual Meeting 2017

The American College of Chest Physicians has released new lung cancer screening guidelines with updated recommendations and evidence. The manuscript has been submitted to CHEST for publication and findings will be presented at the CHEST 2017 Annual Meeting. 

The updated guidelines go beyond just discussing the harms and benefits of screening, guideline chair, Peter Mazzone, MD, FCCP noted. "We addressed implementation of low-dose CT [LDCT] screening, including who to screen, how to identify appropriate patients for screening, how to conduct a shared-decision-making visit, how to perform LDCT and how to manage abnormal findings."

Some of the major recommendations include: 

  • For asymptomatic smokers and former smokers aged 55–77 years who have smoked ≥30 pack-years and either continue to smoke or have quit within the past 15 years, annual screening with low-dose CT should be offered.
  • For asymptomatic smokers and former smokers who do not meet the smoking and age criteria in Recommendation #1 but are deemed to be at high risk of having/developing lung cancer based on clinical risk prediction calculators, low-dose CT screening should not be routinely performed.
  • For individuals who have accumulated <30 pack-years of smoking or are aged <55 years or >77 years, or have quit smoking more than 15 years ago, and do not have a high risk of having/developing lung cancer based on clinical risk prediction calculators, low-dose CT screening should not be performed.
  • For individuals with comorbidities that adversely influence their ability to tolerate the evaluation of screen-detected findings, or tolerate treatment of an early stage screen-detected lung cancer, or that substantially limit their life expectancy, low-dose CT screening should not be performed.

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The experts emphasize that the potential benefits and harms of screening to lower cancer-related deaths must be balanced. The guidelines describe the potential harms of screening such as physical and psychosocial effects, overdiagnosis, and overtreatment. "For this reason, our recommendations for screening have evolved to be even more selective and specifically target those highest risk populations," said guideline panelist Gerard Silvestri, MD, FCCP. 

For more information visit chestnet.org.