CHEST Guidelines-Screening-for-Lung-Cancer_2021

Screening-for-Lung-Cancer_2021_chest

Pdf Summary

The CHEST Guideline and Expert Panel Report provides updated recommendations for lung cancer screening using low-dose CT (LDCT) scans, building on evidence from the National Lung Screening Trial (NLST) and other studies to minimize potential harms and optimize benefits. Here are the key points:

1. <strong>Screening Criteria</strong>:
   - Strongly recommended for individuals aged 55 to 77 with a smoking history of 30 pack-years or more, who currently smoke, or have quit within the past 15 years.
   - Suggested for those aged 50 to 80 with a 20 pack-year history, aligning with 2021 USPSTF guidelines.
   - Patients beyond these criteria may still benefit from screening based on validated risk prediction tools and life expectancy.

2. <strong>Implementation</strong>:
   - Screening should be conducted through high-quality programs that incorporate shared decision-making and smoking cessation support.
   - Symptomatic individuals should not be screened but undergo diagnostic testing.

3. <strong>Screening Process Recommendations</strong>:
   - A clear protocol defining nodule sizes (4, 5, or 6 mm) as positive tests should be established to manage follow-up procedures and minimize false positives.
   - Programs need comprehensive strategies to ensure annual compliance with screening and effective management of detected nodules.
   - Structured reporting systems like Lung-RADS should be used for consistency.

4. <strong>Safety and Impact</strong>:
   - The guidelines acknowledge potential harms like overdiagnosis, radiation exposure, and procedural complications, urging programs to carefully evaluate and document these risks.
   - Evidence indicates that individuals undergoing LDCT have higher cessation rates than those not screened, emphasizing the role of screening as a dual opportunity for cancer detection and smoking cessation intervention.

5. <strong>Data and Evaluation</strong>:
   - Programs should have robust data collection systems to facilitate ongoing evaluation of screening outcomes and report to the national registry for continuous quality improvement.

These recommendations emphasize individual risk evaluation, high-quality program implementation, and balancing screening benefits against potential harms, aligning with current clinical best practices and coverage policies.

Keywords

lung cancer screening

low-dose CT scans

screening criteria

smoking history

USPSTF guidelines

shared decision-making

nodule management

Lung-RADS

overdiagnosis risks

smoking cessation