The role of CT screening for lung cancer: Recommendations from the American College of Chest Physicians and the American Society of Clinical Oncology¹

Recommendation 1	For smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack years or more and either continue to smoke or have quit within the past 15 years, we suggest that annual screening with low-dose CT should be offered over both annual screening with chest radiograph or no screening, but only in settings that can deliver the comprehensive care provided to NLST participants. Grade of recommendation: 2B
Remark 1	Counseling should include a complete description of potential benefits and harms, as outlined in Tables 1 and 2, so the individual can decide whether or not to undergo LDCT screening.
Remark 2	Screening should be conducted in a center similar to those where the National Lung Screening Trial was conducted, with multi-disciplinary coordinated care and a comprehensive process for screening image interpretation, management of findings, and evaluation and treatment of potential cancers.
Remark 3	A number of important questions about screening could be addressed if individuals who are screened for lung cancer are entered into a registry that captures data on follow-up testing, radiation exposure patient experience, and smoking behavior.
Remark 4	Quality metrics should be developed such as those in use for mammography screening, which could help enhance the benefits and minimize the harm for individuals who undergo screening.
Remark 5	Screening for lung cancer is not a substitute for stopping smoking. The most important thing patients can do to prevent lung cancer is not smoke.
Remark 6	The most effective duration or frequency of screening is not known.
Recommendation 2	For individuals who have accumulated fewer than 30 pack years of smoking or are either younger than age 55 or older than 74, or individuals who quit smoking more than 15 years ago, and for individuals with severe comorbidities that would preclude potentially curative treatment and/or limit life expectancy, we suggest that CT screening should not be performed. Grade of recommendation: 2C.

¹Full text of the ACCP and ASCO evidence based practice guideline on the role of CT screening for lung cancer is available in the online appendix.