Pulmonary nodule screening

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have smoking history of 30 pack years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

Screening

Guidelines

• According to the U.S. Preventive Services Task Force (USPSTF), screening for suspected lung cancer by low-dose computed tomography is recommended every year among smokers who are between 55 to 80 years old and who have smoking history of 30 pack years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

• According to the clinical practice guideline issued by the American College of Chest Physicians (CHEST) in 2013, screening for suspected lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are 55 to 74 years old and who have smoked for 30 years or more and either continue to smoke or have quit within the past 15 years.

Strategies

• Low-dose helical computed tomography

• Benefits

• There is evidence that screening individuals aged 55 to 74 years who have smoking histories of 30 or more pack years and who, if they are former smokers, have quit within the last 15 years, reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.

• Harms

• The majority of of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis.
• False-positive exams may result in unnecessary invasive diagnostic procedures.

• Chest x-ray

• Benefits

• Screening with chest x-ray does not reduce mortality from lung cancer in the general population or in ever-smokers.

• Harms

• False positive result
• The majority of of all positive chest x-ray screening exams do not result in a lung cancer diagnosis.
• False-positive exams result in unnecessary invasive diagnostic procedures.

Overdiagnosis

• Based on the current evidence, the majority of solitary pulmonary nodules detected by screening chest x-ray appear to represent overdiagnosed cancer.
• The magnitude of overdiagnosis appears to be between 5% and 25%.
• These cancers result in unnecessary diagnostic procedures and also lead to unnecessary treatment.
• Harms of diagnostic procedures and treatment occur most frequently among long-term and/or heavy smokers because of smoking-associated comorbidities that increase risk propagation.