Abstract:

The National Comprehensive Cancer Network (NCCN) updated the Clinical Practice Guidelines for Lung Cancer Screening (version 2. 2022). In this version, only two factors, age and smoking history, are used to stratify people into high and low risk groups. Individuals aged ≥50 years with a smoking history ≥20 pack per year are at high risk for lung cancer. Low-dose CT (LDCT) screening is recommended for high-risk individuals. The NCCN guidelines are based on the data of randomized trials conducted in the North American population, whose lung cancer disease spectrum differs from that of the Chinese population in terms of disease characteristics and risk factors. Therefore, Chinese physicians should refer to the 2022 NCCN guidelines combined with the characteristics of the Chinese population in clinical practice. In China, individuals are at high risk for lung cancer if they are aged 50-75 years with at least one additional risk factor (≥20 pack/year smoking history, secondhand smoke exposure, occupational exposure, cancer history or family history of lung cancer, disease history of COPD or pulmonary fibrosis). The benefits of lung cancer screening include decreasing lung cancer mortality, improving life quality, and detecting other hidden health risks (breast cancer, thyroid nodules, asymptomatic coronary artery disease, aortic aneurysms, etc). The use of lung nodule risk calculators by multidisciplinary teams with expertise in thoracic radiology, pulmonary medicine, and thoracic surgery for risk assessment is recommended. The disadvantages of lung cancer screening include over-screening or even ineffective screening for indolent lesions, and ineffective screening for small invasive tumors. It suggests that Chinese physicians need to consider the actual situation, weigh the pros and cons, and seek optimal decision-making.

Key words: Lung cancer screening, Low-dose computed tomography, Lung nodule