Eligible heavy smokers should have an annual low-dose chest CT
For eligible heavy smokers, annual low-dose CT reduced lung cancer deaths by 20% and overall deaths by 6.7% compared with chest X-rays alone. The tradeoff is further testing and worry after suspicious results.
What it takes
In China, RMB 200–400 per scan, taking about 10 minutes. Also account for follow-up testing after false alarms and the anxiety while waiting.
What you may gain
The US NLST randomized trial enrolled 53,454 people aged 55–74 with at least 30 pack-years of smoking and, if former smokers, no more than 15 years since quitting. One pack-year means one pack daily for one year. Low-dose CT reduced lung cancer mortality by 20.0% relative to chest radiography (95% CI 6.8–26.7) and all-cause mortality by 6.7% (95% CI 1.2–13.6).
Context & considerations
This recommendation applies only to high-risk smokers. In the same trial, 24.2% of low-dose CT examinations produced suspicious findings, 96.4% of which were false positives. The source cautions that screening nonsmokers this way may amount to paying for anxiety.
Research & references
National Lung Screening Trial Research Team (2011). Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1102873