Start annual LDCT screening
A low-dose CT scan each year, with a follow-up protocol if a nodule or other finding appears.
In the National Lung Screening Trial, three rounds of annual LDCT reduced lung cancer mortality compared with chest radiograph; 323 people needed to be screened to prevent 1 lung cancer death over 6.5 years of follow-up.
Applies to: High-risk current and former smokers aged 55 to 74 in the NLST.
In the NELSON trial, four rounds of LDCT at increasing intervals reduced lung cancer mortality compared with no screening; 130 people needed to be screened to prevent 1 lung cancer death over 10 years of follow-up.
Applies to: High-risk current and former smokers aged 50 to 74 in NELSON.
For every 1000 people screened in the NLST, false-positive results led to 17 invasive procedures, and fewer than 1 person had a major complication.
Applies to: NLST participants. Most studies reviewed did not use current nodule evaluation protocols.
Overdiagnosis estimates varied greatly across studies, from a 0% to a 67% chance that a lung cancer was overdiagnosed.
Applies to: Across the trials reviewed.
Incidental findings were common, with estimates ranging from 4.4% to 40.7% of people screened.
Applies to: Across the trials reviewed.
Harms include increases in distress and, rarely, radiation-induced cancer.
Applies to: People screened with LDCT.
Screening is annual, and is 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.
Applies to: Adults aged 50 to 80 meeting the smoking-history criteria.