The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Lung Cancer Screening Discussion of Procedures by Variant Variant 1: Lung cancer screening. Patient 50 to 80 years of age and 20 or more packs per year smoking history and currently smoke or have quit within the past 15 years. Initial imaging. CT Chest With IV Contrast There is no relevant literature regarding the use of CT with intravenous (IV) contrast for lung cancer screening. CT Chest Without and With IV Contrast There is no relevant literature regarding the use of CT without and with IV contrast for lung cancer screening. CT Chest Without IV Contrast Screening The population described in this variant exactly matches the updated USPSTF eligibility guidelines for lung cancer screening [12]. These guidelines were expanded from the original eligibility criteria studied in the NLST. The NLST enrolled 53,454 participants 55 to 74 years of age with a 30 pack-year history of smoking, who were either currently using tobacco or had tobacco use in the previous 15 years. This randomized controlled study demonstrated a 20% reduction lung cancer mortality with annual CT imaging [3]. Screening for lung cancer at an earlier age and with less tobacco exposure than suggested with the original guidelines may help to improve racial and gender disparities in lung cancer screening eligibility [15]. In fact, the original guidelines may have exacerbated disparities in lung cancer morbidity and mortality for women, underrepresented minorities, and vulnerable patients of low socioeconomic status [22-24].
Lung Cancer Screening PCAs. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Lung Cancer Screening Discussion of Procedures by Variant Variant 1: Lung cancer screening. Patient 50 to 80 years of age and 20 or more packs per year smoking history and currently smoke or have quit within the past 15 years. Initial imaging. CT Chest With IV Contrast There is no relevant literature regarding the use of CT with intravenous (IV) contrast for lung cancer screening. CT Chest Without and With IV Contrast There is no relevant literature regarding the use of CT without and with IV contrast for lung cancer screening. CT Chest Without IV Contrast Screening The population described in this variant exactly matches the updated USPSTF eligibility guidelines for lung cancer screening [12]. These guidelines were expanded from the original eligibility criteria studied in the NLST. The NLST enrolled 53,454 participants 55 to 74 years of age with a 30 pack-year history of smoking, who were either currently using tobacco or had tobacco use in the previous 15 years. This randomized controlled study demonstrated a 20% reduction lung cancer mortality with annual CT imaging [3]. Screening for lung cancer at an earlier age and with less tobacco exposure than suggested with the original guidelines may help to improve racial and gender disparities in lung cancer screening eligibility [15]. In fact, the original guidelines may have exacerbated disparities in lung cancer morbidity and mortality for women, underrepresented minorities, and vulnerable patients of low socioeconomic status [22-24].