Screening for lung cancer: 2023 guideline update from the American Cancer Society.

Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

Wolf AMD ，Oeffinger KC ，Shih TY ，Walter LC ，Church TR ，Fontham ETH ，Elkin EB ，Etzioni RD ，Guerra CE ，Perkins RB ，Kondo KK ，Kratzer TB ，Manassaram-Baptiste D ，Dahut WL ，Smith RA ... -  《-》

Accelerating integration of tobacco use treatment in the context of lung cancer screening: Relevance and application of implementation science to achieving policy and practice.

Based on the findings from the National Lung Screening Trial, the U.S. Preventive Services Task Force recommends annual low dose computed tomography (LDCT) lung cancer screening (LCS) among high-risk adults. Approximately 54% of individuals seeking LCS report current cigarette smoking. Effective smoking cessation interventions, offered at the time of LCS, enhances the health benefits of screening that are attributable to reductions in lung cancer overall and tobacco-related mortality. Considering these data, the Centers for Medicare & Medicaid Services' (CMS) 2015 decision to cover LCS with LDCT required that radiology imaging facilities make tobacco cessation interventions available for people who smoke. In February 2022, CMS reversed their 2015 coverage requirement for delivering tobacco use treatment at the time of LDCT; CMS retained the requirement for counseling during the shared decision-making visit prior to the exam. The policy change does not diminish the importance of offering high-quality tobacco cessation services in conjunction with routine LDCT for LCS. However, LCS programs face a range of barriers to implementing tobacco use treatment in their settings. As a result, implementation has lagged. Closing the "evidence to practice" gap is the focus of implementation science, a field that offers a set of rigorous methods and a systematic approach to identifying and overcoming contextual barriers to implementing evidence-based guidelines in a range of clinical settings. In this paper, we describe how implementation science frameworks and methods can be used to help guide LCS programs in their efforts to integrate tobacco use treatment and discuss policy changes needed to further facilitate the delivery of TUT as an essential component of the LCS process.

Shelley D ，Wang VH ，Taylor K ，Williams R ，Toll B ，Rojewski A ，Foley KL ，Rigotti N ，Ostroff JS ... -  《-》

Lung Cancer Screening in the US, 2022.

Bandi P ，Star J ，Ashad-Bishop K ，Kratzer T ，Smith R ，Jemal A ... -  《-》

Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society.

Oeffinger KC ，Fontham ET ，Etzioni R ，Herzig A ，Michaelson JS ，Shih YC ，Walter LC ，Church TR ，Flowers CR ，LaMonte SJ ，Wolf AM ，DeSantis C ，Lortet-Tieulent J ，Andrews K ，Manassaram-Baptiste D ，Saslow D ，Smith RA ，Brawley OW ，Wender R ，American Cancer Society ... -  《-》

Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement.

US Preventive Services Task Force ，Krist AH ，Davidson KW ，Mangione CM ，Barry MJ ，Cabana M ，Caughey AB ，Davis EM ，Donahue KE ，Doubeni CA ，Kubik M ，Landefeld CS ，Li L ，Ogedegbe G ，Owens DK ，Pbert L ，Silverstein M ，Stevermer J ，Tseng CW ，Wong JB ... -  《-》