Article Figures & Data
Figures
- Figure 1
The lung cancer screening process (primary care physician vs subspecialty).
CMS = Centers for Medicare and Medicaid Services; LDCT = low-dose helical computed tomography; Lung-RADS = Lung CT Screening Reporting & Data System; SDM = shared decision making.
aEligibility for screening is defined primarily on age and smoking criteria, but some risk stratification approaches include other factors not in the US Preventive Service Task Force recommendations, such as radon and occupational exposures and family history. Age criteria vary across guidelines and CMS coverage guidance but is generally in the 50-80 years age group. Patients who are not healthy enough to undergo treatment should not be screened.
Tables
Organization Year Population Endorse LDCT Recommended Setting Smoking Cessation SDMa National Comprehensive Cancer Network (NCCN)9 2012 NLST criteria,8 aged ≥50 years with ≥20 pack-years plus 1 risk factorb and 1.3% PLCO risk Yes Multidisciplinary team Yes Yes American Association for Thoracic Surgery10 2012 Aged 55-79 or 50-79 years based on smoking history and other factorsc Yes Multidisciplinary team Yes US Preventive Services Task Force11 2013 Age pack-year and current smoker or quit ≤ 15 years Yes Primary care; NCCN guidance Yes Yes American Cancer Society12 2013 NLST + imaging/treatment feasible Yes NLST-like Yes American College of Chest Physicians13 2013 NLST Yes NLST-like Yes American Lung Association14 2015 NLST Yes NLST-like Yes Yes Canadian Task Force on Preventive Health Care15 2016 NLST Yes Early diagnosis/treatment expertise Yes European Union16 2017 Validated risk stratification Yes Multidisciplinary teams Yes CHEST Guideline17 2018 55-77 years/NLST smoking criteria Yes Yes AAFP18 2013 High risk (age and smoking) Noa Yes Yes CMS19 2015 55-77 years/NLST smoking criteria Yes Provider/facility quality Yes Yes AAFP = American Academy of Family Physicians; CHEST = American College of Chest Physicians; CMS = Centers for Medicare and Medicaid Services; LDCT = low-dose helical CT; NLST = National Lung Screening Trial; PLCO = Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial; SDM = shared decision making.
↵a Shared decision making endoresed or implied.
↵b Other NCCN risk factors include radon exposure, occupational exposure, history of cancer, family history of lung cancer, COPD, and pulmonary fibrosis.
↵c People aged 55-79 years with ≥30 pack-year of smoking history or people aged 50-79 years with ≥20 pack-year of smoking history with personal lung cancer history or another risk factor such as COPD, environmental or occupational exposure, prior cancer or radiation therapy, genetic predisposition or family history.
d Insufficient evidence to recommend screening. Screening cannot be recommended on the basis of a single study conducted in major medical centers.
