American College of Chest Physicians Release New Lung Cancer Screening Guidelines

10/30/17

Experts in lung cancer are set to reveal key recommendations and updates to screening evidence at the CHEST Annual Meeting (October 28 – November 1, 2017; Toronto, Canada).

The CHEST Annual Meeting is largely considered the premier educational event for physicians and experts in clinical chest medicine. A recent manuscript, “Screening for Lung Cancer: CHEST Guideline and Expert Panel Report,” was submitted to the journal CHEST and will be presented in full at the conference.

Key updates from the previous lung cancer screening guidelines include:

  • For asymptomatic smokers and former smokers aged 55 to 77 years who have smoked 30 pack-years or more 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 above but are deemed to be at high risk of having or developing lung cancer based on clinical risk prediction calculators, low-dose CT screening should not be routinely performed.
  • For individuals who have accumulated fewer than 30 pack-years of smoking or are aged younger than 55 or older than 77 years, or have quit smoking more than 15 years ago, and do not have a high risk of having or 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.

"This guideline differs from our previous guideline as we went beyond discussing harms and benefits," said Peter Mazzone, MD, FCCP, chair of the guideline committee, in a press release (October 26, 2017). "We addressed implementation of low-dose CT screening, including who to screen, how to identify appropriate patients for screening, how to conduct a shared-decision-making visit, how to perform low-dose CT, and how to manage abnormal findings."

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The recommendation summary and comments for each recommendation and abstract can be found on the website of the American College of Chest Physicians. A forthcoming complete manuscript will be published in CHEST.

“The evidence currently does not support widespread adoption of lung cancer screening outside of those patients described in our recommendations,” clarified Gerard Silvestri, MD, FCCP, guideline panelist, CHEST immediate past president (October 26, 2017).—Zachary Bessette