Putting Prevention into Practice
An Evidence-Based Approach
Screening for Lung Cancer
Am Fam Physician. 2021 Jul ;104(1):79-80.
Author disclosure: No relevant financial affiliations.
S.J., a 68-year-old Black man, comes to your office to establish care after recently moving to the area. S.J. has a history of allergic rhinitis, osteoarthritis, and gastroesophageal reflux disease. Additionally, he has a 39-pack-year history of smoking but quit six years ago. He is retired but previously worked at an automobile factory. He reports some mild fatigue. He is concerned about his risk for lung cancer and asks whether he should be screened.
Case Study Questions
1. Based on the U.S. Preventive Services Task Force (USPSTF) recommendation statement, how should you counsel this patient?
A. S.J. should be screened for lung cancer with chest radiography.
B. S.J. should not be screened for lung cancer because he quit smoking more than five years ago.
C. S.J. should be screened for lung cancer using sputum cytology and measurement of biomarker levels because he is younger than 70 years.
D. S.J. should be screened for lung cancer with low-dose computed tomography (CT).
2. According to the USPSTF recommendation, how frequently should this patient be screened for lung cancer as long as he remains in good health?
A. Annual screening should be performed until 15 years have elapsed since smoking ceased.
B. Biennial screening should be performed until 10 years have elapsed since smoking ceased.
C. Screening should be performed every three years until 15 years have elapsed since smoking ceased.
D. Screening should be performed every five years until 20 years have elapsed since smoking ceased.
E. Screening should be performed once.
3. According to the USPSTF, which of the following are the two most important risk factors for lung cancer?
A. Family history.
C. Prior radiation therapy.
D. Environmental exposures.
E. Older age.
1. The correct answer is D. The USPSTF recommends annual screening for lung cancer with low-dose CT in adults 50 to 80 years of age who have at least a 20-pack-year smoking history and currently smoke or have quit within the past 15 years.
1. Krist AH, Davidson KW, Mangione CM, et al. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(10):962–970.
2. Jonas DE, Reuland DS, Reddy SM, et al. Screening for lung cancer with low-dose computed tomography: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2021;325(10):971–987.
3. Meza R, Jeon J, Toumazis I, et al. Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force. JAMA. 2021;325(10):988–997.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening.
This series is coordinated by Kenny Lin, MD, MPH, deputy editor.
A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.
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