Highlights of CHEST's 2018 Updated Lung Cancer Screening Guidelines

By: Dr. Peter Mazzone

January 25, 2018

An update to CHEST’s lung cancer screening guideline, Screening for Lung Cancer: CHEST Guideline and Expert Panel Report has just been published online in the journal CHEST®. This update was made possible by the hard work of my co-authors and the amazing support of the CHEST staff. Our goal was to update the evidence base for the benefit, harms, and implementation of low-radiation dose chest CT screening, then use this evidence base to produce meaningful and usable recommendations. 

The process for developing the guideline followed the rigorous methodological standards of CHEST in which the evidence was gathered from a systematic literature review, and overall quality of the body of evidence was assessed using the GRADE approach. Recommendations were developed and graded based on this assessment.

There are a few aspects of the new guidelines to highlight. First, we have updated some of the core recommendations; second, we have developed new recommendations related to the implementation of high-quality screening; and third, the CHEST approach to guideline development has evolved to allow us to provide recommendations in which the evidence allows and statements based on experience and expert consensus in which it does not. Through this process we developed six graded recommendations and nine ungraded consensus-based statements.

In this update, a few changes to the core recommendations about who should be screened are worthy to note:

Our remaining recommendation and statements are focused on aspects of screening implementation that influence the balance of benefit and harms of screening and lend to an approach to screening that respects patient values. An extensive literature review, followed by a recommendation or statement, is provided to guide programs in the following areas:

Throughout the recommendations and statements we have tried to be sensitive to the variety of acceptable approaches to screening program organization, ranging from program structures that are entirely decentralized (test ordering, counseling, and management of the findings by the referring provider) to those that are entirely centralized (test ordering, counseling, and management of the findings by the screening program).

Though we have attempted to comprehensively evaluate the literature and balance available evidence with pragmatism and the needs of our patients, we recognize that well-intentioned and informed experts can have different opinions about aspects of our guidelines. This highlights the need for further research to guide the screening community. Most will agree that it is time to increase access to high- quality lung cancer screening programs across the country. We hope that the updated CHEST lung cancer screening guidelines can help catalyze this.

Dr. MazzonePeter Mazzone, MD, MPH, FCCP is a staff member at the Respiratory Institute of the Cleveland Clinic where he directs the lung cancer program and the lung cancer screening program. Dr. Mazzone feels fortunate to have led the CHEST lung cancer screening guidelines update.

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