Screening for Lung Cancer - 2023 Update from the American Cancer Society

Publication Date: November 1, 2023
Last Updated: November 2, 2023

Summary of Recommendations

These recommendations represent updated guidance from the American Cancer Society for asymptomatic persons who are at high risk of lung cancer based on cumulative exposure to tobacco by smoking. The ACS recommends that individuals aged 50–80 years who currently smoke, or formerly smoked, and are at high risk for lung cancer because of a ≥20 pack-year history of cigarette smoking undergo annual LCS with LDCT. They also recommend the elimination of the YSQ criterion for beginning or ending LCS among individuals who formerly smoked. Existing comorbid conditions that substantially limit life expectancy or the inability or unwillingness to undergo evaluation or treatment after positive screening findings are factors that should preclude referrals for screening. Individuals who smoke should be advised to quit and offered evidence-based smoking-cessation counseling and pharmocotherapy to assist in quitting. Eligible individuals should undergo SDM with a qualified health professional that includes a discussion about the purpose of LCS, the consensus among leading organizations who endorse LCS, the screening process and the importance of adherence to regular screening, and the benefits, limitations, and potential harms associated with LCS.
The American Cancer Society recommends annual screening for lung cancer with low-dose computed tomography in asymptomatic individuals aged 50 to 80 years who currently smoke or formerly smoked and have a ≥20 pack-yeara smoking history.
(S, M)
  • For individuals who formerly smoked, the number of years since quitting smoking is not included as an eligibility criterion to begin or to stop lung cancer screening.
  • Individuals with comorbid conditions that substantially limit life expectancy should not be screened.
  • Before undergoing lung cancer screening, individuals should:
    • Receive evidence-based smoking-cessation counseling and offered interventions if they currently smoke; and
    • Engage in a shared decision-making discussion with a health professional about the benefits, limitations, and harms of lung cancer screening (see Table 5 for core elements for shared decision-making).
a One pack-year is the equivalent of smoking an average of 20 cigarettes—one pack—per day for a year.

b A strong recommendation conveys the consensus that the benefits of adherence to that intervention outweigh the undesirable effects that may result from screening.
620

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Screening for Lung Cancer - 2023 Update from the American Cancer Society

Authoring Organization

Publication Month/Year

November 1, 2023

Last Updated Month/Year

November 6, 2023

Document Type

Guideline

Country of Publication

US

Document Objectives

Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50–80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50–80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.
 

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Prevention

Diseases/Conditions (MeSH)

D008171 - Lung Diseases

Keywords

lung cancer, cancer screening, lung cancer screening

Source Citation

Wolf, AMD, Oeffinger, KC, Shih, TY-C, et al. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin. 2023; 1-32. doi:10.3322/caac.21811

Supplemental Methodology Resources

Data Supplement