Squamous cell carcinoma of the lung screening

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2] Maria Fernanda Villarreal, M.D. [3]

According to the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography (LDCT) is recommended every year among smokers who are between 55 to 80 years old and who have history of smoke 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).

Guidelines

• According to the clinical practice guideline by the U.S. Preventive Services Task Force (USPSTF), screening for lung cancer by low-dose computed tomography (LDCT) is recommended every year among smokers and former smokers who are between 55 to 80 years old and who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years (grade B recommendation).^[1][2][3][4]

• According to the American College of Chest Physicians (CHEST) in 2013, screening for lung cancer by low-dose CT (LDCT) is recommended every year among smokers and former smokers who are aged between 55 and 74 years and who have smoked for 30 pack-years or more and either continue to smoke or have quit within the past 15 years.^[5]

• To view all the screening guidelines recommendations for squamous cell lung carcinoma, click here

Strategies

• Low-dose helical computed tomography:^[6]

• Benefits

• There is evidence that screening persons aged 55 to 74 years who have cigarette smoking histories of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.

• Harms

• The majority of of all positive low-dose helical computed tomography screening exams do not result in a lung cancer diagnosis.
• False-positive exams may result in unnecessary invasive diagnostic procedures.

• Chest x-ray and/or sputum cytology:^[7][8][9]

• Benefits

• Screening with chest x-ray and/or sputum cytology does not reduce mortality from lung cancer in the general population or in ever-smokers.

• Harms

• False positive exams
• The majority of all positive chest x-ray screening exams do not result in a true positive diagnosis of lung cancer.
• False-positive exams result in unnecessary invasive diagnostic procedures.

Over-diagnosis

• Based on current evidence, the majority of non-small cell lung cancers detected by screening chest x-ray and/or sputum cytology appear to represent over-diagnosed cancer.^[8]

• The magnitude of over-diagnosis appears to be between 5% and 25%.
• These cancers result in unnecessary diagnostic procedures and also lead to unnecessary treatment.
• Harms of diagnostic procedures and treatment occur most frequently among long-term and/or heavy smokers because of smoking-associated comorbidities that increase risk propagation.

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