Table 3

Recommendations for lung cancer screening programmes with panellist median scores for strategies deemed ‘appropriate’ or ‘uncertain’ after accounting for panel consensus and strength of recommendation

DomainRecommendationScore, median (range)
Strength
MethodLow-dose CT should be used for lung cancer (LC) screening.7.1 (3.6–8.5)
Strongly recommended
PopulationPeople at high-risk of LC, as defined here and with no conditions implying a risk of death higher than the risk of death from LC should be included.7 (1.8–8)
Strongly recommended
High-risk status for the programme target population is defined based on two parameters: age and smoking history (current smoking or smoking history), as defined below.7.1 (5.3–9)
Strongly recommended
Regarding age, high-risk is defined as those persons between 55 and 74 years of age with a history of smoking as detailed below.7.1 (3.6–8)
Strongly recommended
A smoking of ≥30 packs-year is considered high-risk.7.1 (4.5–8)
Strongly recommended
Likewise, former smokers with more than 30 packs-year who quit smoking within 15 years are also considered high-risk.7.1 (4.5–8)
Strongly recommended
All people at high-risk as defined here should be included in LC screening, regardless of their sex.7.1 (5.3–9)
Strongly recommended
ImplementationLCS should have an annual interval.7 (4–8)
Strongly recommended
Yearly LCS should be stopped if at least one of the following conditions is met:

  1. Fifteen years have elapsed from the time the person quit smoking.

  2. The person’s physical condition suggests a short life expectancy.

  3. The person is unable to continue with the programme, or is reluctant to continue with the screening.

  4. The person is over 80 years of age.

7 (4.5–8)
Strongly recommended
The cardiovascular risk of the persons included should be evaluated within the screening programme.7.1 (4.5–8.5)
Strongly recommended
A positive finding is defined as the finding of a solid nodule with a diameter of ≥6 mm (or volume of ≥113 mm3) on baseline screening or the finding of a nodule with a diameter of ≥4 mm in a patient who has previously presented a negative screening. This finding will lead to a recommendation for additional testing, other than annual screening, according to the Lung-RADS (Lung CT Screening Reporting And Data System) categories.7 (4.5–8)
Strongly recommended
Programme characteristicsLCS programmes should have a multidisciplinary committee of professionals.7.1 (6.2–9)
Strongly recommended
LCS programmes should have pre-established protocols for clinical decision-making about lung nodule management.7.1 (5.5–9)
Strongly recommended
LCS programmes should have strategies for the management of symptomatic patients who do not meet the requirements for entry into the screening programme so that they can receive an appropriate diagnosis.7.1 (5.5–9)
Strongly recommended
Every smoker enrolled in the screening programme should be offered a smoking cessation programme, integrated with the screening programme, to reduce the long-term burden of this disease.7.1 (5.9–9)
Strongly recommended
Screening programmes should ensure the distribution of educational materials for the population and for healthcare providers with information on the benefits and risks of screening.7.1 (5.5–9)
Strongly recommended

  • LC, lung cancer; LCS, lung cancer screening; LDCT, low-dose CT.