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ACS updates lung cancer screening guidelines to ensure earlier diagnosis and treatment

by John R. Fischer, Senior Reporter | November 08, 2023
CT X-Ray
The American Cancer Society has updated its lung cancer screening guideline for the first time in a decade.
In its new guidelines, the American Cancer Society is recommending annual CT lung cancer screenings for individuals between 50 and 80 who smoke or formerly smoked and have a pack-year history of 20 years or more.

The recommendations are the first update made by the ACS since 2013 when it called for those between 55 and 74 with a pack-year history of 30 years or more to be screened. The previous guideline also suggested screenings for those who quit smoking 15 years prior, but the new one eliminates this requirement and has no time limit on when a person has quit smoking.

ACS also recommends that individuals consult their physicians about the benefits, harms, and limits of low-dose CT screenings annually, and for those who still smoke to seek help quitting.
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“Recent studies have shown extending the screening age for persons who smoke and formerly smoked, eliminating the ‘years since quitting’ requirement and lowering the pack per year recommendation could make a real difference in saving lives,” said Dr. Robert Smith, senior vice president of early cancer detection science at the American Cancer Society, and lead author of the lung cancer screening guideline report, in a statement.

Additionally, the guideline stresses that those with health conditions that limit life expectancy and affect their ability or willingness to seek treatment for the disease if diagnosed not get screened.

Current U.S. Preventive Services Task Force recommendations also say that 50- to 80-year-olds with a 20-pack-year smoking history, who are currently smoking or have quit in the last 15 years, should undergo LDCT scans. Guidelines like these, however, have come under scrutiny, with some clinicians saying that age and smoking history alone are not enough to combat lung cancer diagnoses and mortality.

Earlier this year, researchers at the Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group, said that advanced models that incorporate additional factors such as sex, race and ethnicity, personal cancer history, family history of lung cancer, body mass index, and other significant factors may be more cost-effective and result in more quality-adjusted life years.

Additionally, a Harvey L. Neiman Health Policy Institute study in April found that despite being covered and owing nothing out-of-pocket, less than 2% of eligible Americans with private insurance undergo LDCT screenings, indicating a need to develop effective strategies for reducing screening deterrents. Even among the highest groups, Original Medicare and Medicare Advantage beneficiaries, screening was just 3.4% and 4.6%, respectively, with potential factors including lack of awareness, access, and social determinants, said the researchers.

The guideline report also includes a patient page, an editorial from the ACS flagship journal, CA: A Cancer Journal for Clinicians, and a systematic review of evidence that supports the changes.

The new guideline was published in CA: A Cancer Journal for Clinicians. Modeling papers and epidemiologic research supporting the guideline, and an updated analysis of the benefit-to-radiation-risk ratio from screening, are also published in the ACS journal, Cancer.

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