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Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines Online Only Articles |

Screening for Lung CancerScreening for Lung Cancer: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

Frank C. Detterbeck, MD, FCCP; Peter J. Mazzone, MD, MPH, FCCP; David P. Naidich, MD, FCCP; Peter B. Bach, MD, FCCP
Author and Funding Information

From the Yale University School of Medicine (Dr Detterbeck), New Haven, CT; Respiratory Institute (Dr Mazzone), The Cleveland Clinic, Cleveland, OH; NYU Langone Medical Center (Dr Naidich), Tisch Hospital, New York, NY; and Memorial Sloan-Kettering Cancer Center (Dr Bach), New York, NY.

Correspondence to: Frank C. Detterbeck, MD, FCCP, Yale School of Medicine, 330 Cedar St, PO Box 208062, New Haven, CT 06520-8062; e-mail: frank.detterbeck@yale.edu


COI grids reflecting the conflicts of interest that were current as of the date of the conference and voting are posted in the online supplementary materials.

Disclaimer: American College of Chest Physician guidelines are intended for general information only, are not medical advice, and do not replace professional medical care and physician advice, which always should be sought for any medical condition. The complete disclaimer for this guideline can be accessed at http://dx.doi.org/10.1378/chest.1435S1.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Sponsors: The overall process for the development of these guidelines, including matters pertaining to funding and conflicts of interest, are described in the methodology article.1 The development of this guideline was supported primarily by the American College of Chest Physicians. The lung cancer guidelines conference was supported in part by a grant from the Lung Cancer Research Foundation. The publication and dissemination of the guidelines was supported in part by a 2009 independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.


Chest. 2013;143(5_suppl):e78S-e92S. doi:10.1378/chest.12-2350
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Background:  Lung cancer is by far the major cause of cancer deaths largely because in the majority of patients it is at an advanced stage at the time it is discovered, when curative treatment is no longer feasible. This article examines the data regarding the ability of screening to decrease the number of lung cancer deaths.

Methods:  A systematic review was conducted of controlled studies that address the effectiveness of methods of screening for lung cancer.

Results:  Several large randomized controlled trials (RCTs), including a recent one, have demonstrated that screening for lung cancer using a chest radiograph does not reduce the number of deaths from lung cancer. One large RCT involving low-dose CT (LDCT) screening demonstrated a significant reduction in lung cancer deaths, with few harms to individuals at elevated risk when done in the context of a structured program of selection, screening, evaluation, and management of the relatively high number of benign abnormalities. Whether other RCTs involving LDCT screening are consistent is unclear because data are limited or not yet mature.

Conclusions:  Screening is a complex interplay of selection (a population with sufficient risk and few serious comorbidities), the value of the screening test, the interval between screening tests, the availability of effective treatment, the risk of complications or harms as a result of screening, and the degree with which the screened individuals comply with screening and treatment recommendations. Screening with LDCT of appropriate individuals in the context of a structured process is associated with a significant reduction in the number of lung cancer deaths in the screened population. Given the complex interplay of factors inherent in screening, many questions remain on how to effectively implement screening on a broader scale.

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