Pulmonary nodule screening

Pulmonary Nodule Microchapters
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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 history of smoke 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 history of smoke 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 age 55 to 74 and who have smoked for 30 pack-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 persons aged 55 to 74 years who have cigarette 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 exams
• 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 current evidence, the majority of solitary pulmonary nodules detected by screening chest x-ray appear to represent over-diagnosed 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.