People aged 50–80 years who are current smokers or have quit and have a smoking history of 20 or more pack-years should be screened annually with low-dose computed tomography, according to the American Cancer Society’s (ACS’s) 2023 updated lung cancer screening guidelines.
The new version, which ACS released in November 2023, expands eligibility criteria for people who are at high risk for lung cancer because of smoking, which could promote earlier detection. It also widens the age range (previously 55–74 years of age), reduces the pack-year recommendation (previously 30 or more pack-years), and removes the requirement for a maximum of 15 years since quitting, which evidence from randomized controlled trials showed reduced lung cancer mortality.
The guideline also includes recommendations on the choice to proceed to screening and cancer risk:
- Patients and healthcare providers should engage in shared decision-making prior to screening.
- Current smokers should receive counseling and resources on quitting.
- Patients with comorbidities that substantially limit life expectancy should not be screened.
The guideline authors determined that reducing lung cancer mortality was the most desirable effect of screening. Although lung cancer mortality rates are declining, the disease remains the leading cause of cancer death. ACS estimates “that in 2023, there will be 238,340 new cases of lung cancer, and 127,070 people will die from lung cancer, accounting for approximately 20% of all cancer deaths.” The guideline authors weighed the reduction in lung cancer deaths against several factors, including overdiagnosis, long-term harms of repeat examinations, and patient burdens associated with multiple examinations and ultimately determined that the benefits outweighed the risks.
The authors recognized disparities across the studies used to develop the guideline. Primarily, the randomized controlled trials did not accurately represent the U.S. population eligible for lung cancer screening. Specifically, the vast majority (greater than 90%) of participants were White, and their experience may not accurately reflect the overall population’s access to cancer screening and health care in general.
With the changes to screening guidelines, the number of individuals eligible has greatly increased. However, use of lung cancer screening historically has been low, with the American Lung Association reporting that only 5.8% of those eligible were screened in 2021. Nurses are in a prime position to influence uptake of screening, through identification of at-risk individuals, patient counseling, and participation or leadership in a lung cancer screening program.
The release of the new guideline in November coincides with Lung Cancer Awareness Month, which is intended to raise awareness about the effects of this disease, as well as research and prevention efforts. This month also sees the Great American Smokeout on November 16. With this annual event, the American Cancer Society supports tobacco cessation or reduction attempts by offering resources and education on the benefits of a tobacco-free life.