Domain | Recommendation | Score, median (range) Strength |
Method | Low-dose CT should be used for lung cancer (LC) screening. | 7.1 (3.6–8.5) Strongly recommended |
Population | People 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 | |
Implementation | LCS 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:
| 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 characteristics | LCS 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.