The American College of Chest Physicians recommends screening with low-
dose computed tomography — but only in a carefully defined population.

The American College of Chest Physicians has published a new clinical 
guideline on screening for lung cancer. The key recommendation is:

“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 
LDCT [low-dose computed tomography] should be offered . . . but only 
in settings that can deliver the comprehensive care provided to NLST 
[National Lung Screening Trial] participants.”

This cautious language reflects several points that the guideline 
addresses in detail. First, because the NLST is the only randomized 
trial that has shown a mortality benefit (JW Gen Med Jul 14 2011), the 
authors believe that screening should be limited to people whose age 
and smoking histories meet the NLST eligibility criteria.

Second, the authors acknowledge the problem of false positives — 
i.e., CT scans can identify abnormalities that generate additional 
tests and procedures in people who don’t have lung cancer (JW Gen Med 
May 22 2013). Further evaluation of patients with false-positive scans 
is costly, potentially anxiety-provoking, and potentially harmful if 
invasive tests are performed.

Third, the authors are concerned about screening that is done 
haphazardly in community practice settings. Many patients with benign 
nodules can be followed without undergoing biopsies, and very few 
patients with benign nodules should need surgery to establish 
benignity. When diagnostic surgery is required, video-assisted 
thoracic surgery is preferable. The authors believe that screening 
should be done only in centers where expert multidisciplinary 
management and follow-up are available.