Lung cancer remains the leading cause of cancer death in the United States, with the majority of lung cancer cases associated with smoking.27,28 Despite successful efforts to decrease tobacco use, 37% of American adults are former or current smokers and are therefore at higher risk for developing malignancy.28 Approximately 6% of adults in the US will be diagnosed with lung and bronchus cancer in their lifetime and an estimated 131,880 people will die of this disease in 2021.27 The 5-year survival rate is 21.7%.27
While lung cancer generally has a poor prognosis, evidence supports that annual screening for high-risk individuals can decrease lung cancer death by 20%.28-30 The USPSTF, ACS, and American Thoracic Society recommend screening with annual low-dose CT as a proven test with high sensitivity and acceptable specificity for the detection of lung cancer in high-risk persons (Table 7).28,30,31 The USPSTF recommends lung cancer screening for people aged 50 to 80 years who have smoked at least 20 pack-years over their lifetime and still smoke or have quit smoking within the last 15 years.28 Clinicians should exclude from screening patients with significant or life-limiting comorbidities and those with metal implants or devices in the chest or back.30
Low-dose CT has significant limitations and potential harms, including a significant risk of obtaining false-positive results and overdiagnosis resulting in the need for invasive procedures and more frequent testing.29 Patients should be counseled that screening does not detect all lung cancers, of the risk associated with radiation exposure, and that positive screening does not necessarily prevent lung cancer death.29 Despite these screening guidelines, providers must not overlook smoking cessation counseling for lung cancer prevention. 28-30
Table 7. Lung Cancer Screening Guidelines28-30
|USPSTF28 (2013)||ACS30 (2018)||ACCP29 (2018)|
|Annual LDCT for adults aged 50-80 y with a 20-pack year smoking history and currently smoke or have quit within the past 15 years||Annual LDCT for adults aged 55-74 y with a 30-pack year smoking history who currently smoke or have quit within the past 15 years||Annual LDCT for adults aged 55-77 y with a 30-pack year smoking history and currently smoke or have quit within the past 15 years|
Implications for Clinical Practice
Providers play a significant role in recommending cancer screening and preventing cancer deaths with early dedication by incorporating cancer screening guidelines into routine care. Taking a holistic approach to cancer screening that uses evidence-based screening guidelines and a discussion of patient’s health goals, available resources, and values is central to cancer prevention. For every discussion around cancer screening, providers should engage in shared decision-making with patients regarding harms and benefits of screening. Some high-risk groups, such as those with hereditary cancer syndromes and history of exposure to known carcinogens, may require a more intensive cancer screening strategy. Lastly, clinicians can engage in various health promotion strategies such as immunization, weight loss, and smoking cessation to reduce overall cancer risk.
Michalle Ramirez-McLaughlin, MS, FNP-C, is an assistant clinical professor with the Department of Family Health Care Nursing at the University of California, San Francisco. She maintains a primary care practice at the Marin Community Clinics, a federally qualified health care center in Novato, CA. She is passionate about providing equitable, high-quality care across the lifespan with an emphasis on wellness and prevention.
Michelle Buchholz, MSN, BSN, FNP-BC, is an assistant clinical professor with the Department of Family Healthcare Nursing at University of California, San Francisco. She maintains a clinical practice with Ravenswood Family Health Center, a federally qualified health center in East Palo Alto, CA.
Gabriel Schwartz, MSN, BSN, FNP-BC, is a nurse practitioner with the Department of Gastrointestinal Medical Oncology at University of California, San Francisco. He specializes in the care of patients with liver cancer, bile duct cancer, colon cancer, and other gastrointestinal malignancies.
Gabriel Schwartz, MSN, BSN, FNP-BC, has served as a consultant and speaker for Eisai, Inc, and consultancy fees from Exelixis, Inc. Michalle Ramirez-McLaughlin, FNP-C, and Michelle Buchholz, MSN, BSN, FNP-BC, have no relevant disclosures
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