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:
- the choice of nodule size to define what constitutes a positive test;
- maximizing compliance with annual screening exams;
- developing a comprehensive approach to lung nodule management;
- minimizing overtreatment of potentially indolent lung cancers;
- the provision of evidence-based tobacco cessation treatment;
- providing effective counseling and shared decision-making visits prior to the low-radiation dose CT scan;
- how to perform the low-radiation dose CT scan;
- structured reporting of the exam results, management of non-nodule findings on the low radiation dose CT; and
- the development of data collection and reporting tools that are capable of assisting with quality improvement initiatives.
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.
Coinciding with the publication of the guideline, CHEST has developed new e-learning modules on the benefits and harms of CT screening for lung cancer. The modules are based on the CHEST 2018 educational session on the Screening for Lung Cancer Guidelines. The modules are available at chestnet.org/lungcancerscreening.