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.

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肺癌筛查：美国癌症协会 2023 年指南更新


肺癌是美国男性和女性因癌症死亡和人年寿命损失的主要原因。早期发现已被证明与降低肺癌死亡率有关。我们的目标是更新美国癌症协会 (ACS) 2013 年肺癌高危成人肺癌筛查 (LCS) 指南。该指南旨在为因吸烟史而处于肺癌高风险的医疗保健提供者及其患者提供筛查指导。 ACS 指南制定小组 (GDG) 对受美​​国预防服务工作组 2021 年 LCS 建议更新委托的 LCS 文献进行了系统审查；对与戒烟后年数相关的肺癌风险进行第二次系统评价（YSQ）； 2021年以来出版的文献；两个经过癌症干预和监测模型网络验证的肺癌模型，用于评估筛查的益处和危害；流行病学和模型分析，检验 YSQ 和衰老对肺癌风险的影响；以及 LCS 和后续检查的获益与辐射风险比的最新分析。 GDG 还检查了来自国家癌症研究所监测、流行病学和最终结果计划的疾病负担数据。建议的制定基于证据的质量和关于利弊平衡的判断（纳入价值观和偏好）。 GDG 判断，总体证据是中等的，足以支持对符合资格标准的个人进行筛查的强烈建议。 在一系列研究设计中，50-80 岁男性和女性的 LCS 与肺癌死亡率的降低相关，并且推论证据支持 80 岁以上健康状况良好的男性和女性进行 LCS。 ACS 建议每年对 50-80 岁、目前吸烟或曾经吸烟且有 ≥ 20 包年吸烟史的无症状个体进行低剂量计算机断层扫描 LCS（强烈推荐，证据质量中等）。在决定启动 LCS 之前，个人应与合格的健康专业人员进行共同决策讨论。对于曾经吸烟的个人，YSQ 数量并不是开始或停止筛查的资格标准。目前吸烟的人应该接受戒烟咨询并获得戒烟资源。患有严重限制预期寿命的合并症的个体不应接受筛查。医疗保健提供者和肺癌高危成人在讨论 LCS 时应考虑这些建议。如果得到充分实施，这些建议很可能显着减少美国的肺癌死亡率和患病率。