Annals of Internal Medicine | Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement

Annals of Internal Medicine | Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement

Clinical Guidelines | 31 December 2013

Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement FREE ONLINE FIRST

Virginia A. Moyer, MD, MPH, on behalf of the U.S. Preventive Services Task Force*

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Ann Intern Med. Published online 31 December 2013 doi:10.7326/M13-2771

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Abstract

Abstract | Summary of Recommendation and Evidence | Rationale | Clinical Considerations |Other Considerations | Discussion | Update of Previous USPSTF Recommendation |Recommendations of Others | Appendices | References

Description: Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer.

Methods: The USPSTF reviewed the evidence on the efficacy of low-dose computed tomography, chest radiography, and sputum cytologic evaluation for lung cancer screening in asymptomatic persons who are at average or high risk for lung cancer (current or former smokers) and the benefits and harms of these screening tests and of surgical resection of early-stage non–small cell lung cancer. The USPSTF also commissioned modeling studies to provide information about the optimum age at which to begin and end screening, the optimum screening interval, and the relative benefits and harms of different screening strategies.

Population: This recommendation applies to asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

Recommendation: The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation)

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The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Summary of Recommendation and Evidence

Abstract | Summary of Recommendation and Evidence | Rationale | Clinical Considerations |Other Considerations | Discussion | Update of Previous USPSTF Recommendation |Recommendations of Others | Appendices | References

The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation)

See the Clinical Considerations section for suggestions for implementation in practice.

See the Figure for a summary of the recommendation and suggestions for clinical practice.