New Guideline: At 55 Years of Age, Heavy Smokers Should Begin Annual Lung Cancer Screenings

The latest lung cancer screening recommendations suggest that heavy smokers be screened for the disease annually once they reach 55 years of age.

The risks associated with heavy smokers developing lung cancer outweigh the risks associated with annual screening for the disease, leading the US Preventive Services Task Force (USPSTF) to recommend annual lung cancer screenings in those patients.

“Although lung cancer screening is not an alternative to smoking cessation, the USPSTF found adequate evidence that annual screening for lung cancer with LDCT [low-dose computed tomography] in a defined population of high-risk persons can prevent a substantial number of lung cancer—related deaths,” said the task force’s recommendation statement, which was published online on December 31, 2013, in the Annals of Internal Medicine.

The guideline recommends annual lung cancer screenings using LDCT in patients aged 55 to 80 years who smoked at least 1 pack of cigarettes a day for 30 years or the equivalent, or who quit a heavy smoking habit within the past 15 years.

The annual screenings can be discontinued after patients reach the 15-year quitting mark. Health problems that substantially limit life expectancy or ability or willingness to have lung surgery can also excuse a patient from the annual screening, the USPSTF notes.

“The USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT is of moderate net benefit in asymptomatic persons who are at high risk for lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking,” the report states. “The moderate net benefit of screening depends on limiting screening to persons who are high risk, the accuracy of image interpretation being similar to that found in the NLST (National Lung Screening Trial), and the resolution of most false-positive results without invasive procedures.”

The annual screenings are not without concerns, however. The chance for false—positive results, which could lead to anxiety for patients, additional expenses from follow-up tests, and unnecessary surgeries, is about 95%. The repeated exposure to computed tomography radiation is also a concern for patients, because it can cause cancer as well.

The guideline authors compared the LDCT radiation exposure to that of mammography, and, while noting concern about the duration of LDCT, stated that current practice tends to involve following detected nodules with LDCT rather than higher-radiation high-resolution CT scans.

Prior to the latest update, the Task Force released its last screening guideline in 2004. That guideline found insufficient evidence to establish a benefit from annual lung cancer screenings in high-risk individuals, regardless the test used to detect the cancer.

The most recent update is based on studies reporting results of LDCT screening found by searching MEDLINE, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, reference lists, and Scopus. Although the guideline authors found 8215 abstracts initially, only 67 full-text articles met inclusion criteria. The list was further condensed to 7 randomized, controlled trials reporting LDCT results, and then trimmed to 4 clinical trials reporting test results in intervention and control groups.

The 4 trials included the National Lung Screening Trial, the Detection and Screening of Early Lung Cancer by Novel Imaging Technology and Molecular Essays, the Danish Lung Cancer Screening Trial, and the Multicentric Italian Lung Detection study.

Patient advocacy and physician groups, including the American Cancer Society, the American College of Chest Physicians, the American Association for Thoracic Surgery, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network, have recommend similar lung cancer screening criteria. Several of the screening guidelines are based on the National Lung Screening Trial findings.