American College of Chest Physicians and American Thoracic Society

View all recommendations from this society

Released October 27, 2013

Don’t perform CT screening for lung cancer among patients at low risk for lung cancer.

Low dose chest CT screening for lung cancer has the potential to reduce lung cancer death in patients at high risk (i.e., individuals aged 55-74 with at least a 30-pack year history of tobacco use, who are either still smoking or quit within the past 15 years). However, CT screening for lung cancer also has the potential to cause a number of adverse effects (e.g., radiation exposure, high false positive rate, harms related to downstream evaluation of pulmonary nodules, overdiagnosis of indolent tumors). Thus, screening should be reserved for patients at high risk of lung cancer and should not be offered to individuals at low risk of lung cancer.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

This document was prepared as a joint initiative of the American College of Chest Physicians and the American Thoracic Society. A taskforce with members from both societies was selected, including individuals from diverse backgrounds and clinical areas of expertise. Taskforce members initially proposed 30 items for consideration. The taskforce debated the impact of each based on five criteria (Evidence, Prevalence, Cost, Relevance, Innovation), and agreed to narrow the list to 10 items to explore in greater depth. Following an in-depth evidence review and consultation with external content experts for each item, the taskforce together reviewed and debated the compiled information for all 10 items. Subsequently, taskforce members independently scored each item on a scale of 1–5, rating each item on its overall impact as well as on each of the five criteria. The 5 items with the best mean overall scores were retained in the “penultimate” list. The taskforce then reviewed and edited the wording of items on the penultimate list, and submitted it to both societies’ executive committees. The executive committees sought feedback from additional experts in the field, debated the items, and provided written comments to the taskforce. The taskforce deliberated and incorporated these suggestions where appropriate to create the final list, resolving any conflicts through discussion. Both Societies elected to endorse the final list.

Members of the Task Force were: Renda Soylemez Wiener, MD, MPH (Co-Chair), Scott D. Halpern, MD, PhD (Co-Chair), Daniel R. Ouellette, MD, FCCP (Co-Chair), Edward Diamond, MD, MBA, FCCP, Vincent S. Fan, MD, MPH, Janet R. Maurer, MD, FCCP, Richard A. Mularski, MD, MSHS, MCR, FCCP and Jay I. Peters, MD, FCCP.

Sources

Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395–409.

Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, Byers T, Colditz GA, Gould MK, Jett JR, Sabichi AL, Smith-Bindman R, Wood DE, Qaseem A, Detterbeck FC. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012;307(22):2418–29.

Veronesi G, Maisonneuve P, Bellomi M, Rampinelli C, Durli I, Bertolotti R, Spaggiari L. Estimating overdiagnosis in low-dose computed tomography screening for lung cancer: a cohort study. Ann Intern Med. 2012;157(11):776–84.

Humphrey LL, Deffebach M, Pappas M, Baumann C, Artis K, Mitchell JP, Zakher B, Fu R, Slatore CG. Screening for lung cancer with low-dose computed tomography: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2013 Sep 17;159(6):411–20.