Should My Patient Be Screened for Lung Cancer?

If a patient meets the following criteria, they are considered to be at "high risk" for developing lung cancer and screening is recommended: Patients are considered “high risk” for developing lung cancer, and eligible for a LDCT scan, if they meet all of the criteria outlined by the U.S. Preventative Services Task Force (USPSTF):

• Between 50-80 years of age
• Have a 20 pack-year history of smoking (this means 1 pack a day for 20 years, 2 packs a day for 10 years, etc.)
• Currently smoke, or have quit within the last 15 years

If your patient meets these criteria, annual lung cancer screening is recommended. At this time, there is insufficient evidence to support screening for individuals that fall outside these criteria. 

A note on insurance coverage:
Medicare and many private health insurance plans cover lung cancer screening without cost-sharing, but coverage requirements can vary depending on the plan. Many insurers are still in the process of updating their policies to align with USPSTF guidelines.  Check out our coverage chart to learn more.

Ask the referral facility doing the low-dose CT scan to carefully and clearly explain to your patient all the costs that they may incur and not just the cost of the low-dose CT scan alone. Recommend your patients use the Lung Cancer Screening Insurance Checklist as guidance.

Encourage your patient to check with their insurance plan to confirm whether screening and any follow-up procedures are covered, and to ask if there may be any out-of-pocket costs, even if the LDCT scan itself is free. Also, advise patients to ask the referral facility performing the LDCT to carefully and clearly explain all potential costs, not just the cost of the scan, but any additional services that may be recommended based on results. We recommend patients use the Lung Cancer Screening Insurance Checklist to help guide these conversations and ensure they fully understand their coverage.

Lung cancer screening with a LDCT scan is a complicated process that requires careful patient selection and shared decision-making. Before ordering a screening, it’s important to have a thorough discussion that includes the following:

• Review the patient’s full health history. Gather a complete medical history, including smoking status, family history of cancer, occupational exposures, and other risk factors.
• Determine possible comorbidities. Access whether any health conditions may reduce the potential benefit of screening.
• Discuss the benefits and risks of screening.  Talk about the potential benefits of screening, including early detection and increased treatment options, as well as the risks, such as false positives, overdiagnosis, incidental findings, and radiation exposure. Also discuss additional follow-up tests or procedures that may be recommended based on the results of the scan. 
• Discuss the costs of screening. Even when the scan is covered by insurance, patients may face out-of-pocket costs for follow-up tests or procedures. It’s also important to discuss the emotional impact of waiting for results and the time commitment. 
• Reduce risk. Take time to talk with your patients about their lung cancer risk factors, including smoking, radon exposure, and other environmental or occupational risks. Provide guidance on how to reduce their risk.

For patients who currently smoke, this is an opportunity to offer evidence-based support to them quit. Visit Lung.org/quit-smoking for tools and resources to help your patients succeed.

Regular chest X-rays should never be used for routine lung cancer screening, as they are not effective at detecting early-stage lung cancers compared to low-dose CT scans. LDCT scans are the only screening method proven to reduce lung cancer mortality among individuals at high risk.

When referring a patient for a lung cancer screening, consider the following: 

• A facility accredited for low-dose CT screening by the American College of Radiology.
• A facility using the latest technology specifically designed for lung cancer screening
• An expert multidisciplinary team that can provide follow-up for evaluation of nodules. If the facility does not have on-site expertise, they should have established referral pathways to appropriate specialists or institutions.

Please note, Medicare has a specific protocol in place for physicians and screening institutions. Review these requirements when considering LDCT screening for a patient on Medicare.

When a patient receives the results of their LDCT scan, findings typically fall into one of the three categories:

• Positive Result. A "positive" result means that the low-dose CT scan has detected something abnormal. This is usually a lung nodule of a concerning size or appearance that requires further evaluation. Work with a multidisciplinary team to discuss next steps, which may include additional follow-up, biopsy, or referral to a specialist. Talk to your patient about all appropriate options, including clinical trials.
• Negative Result. A"Negative" result means that there were no abnormal findings on thelow-dose CT scan. You should still discuss the plan for ongoing annual lung cancer screenings if the patient remains eligible and at high risk. 
• Indeterminate Result. There may also be an "indeterminate" result which means something was seen but does not require immediate intervention. In these cases, the recommendation is often watchful waiting, with repeat imaging to monitor for any changes. Decisions should be guided by an experienced specialist or lung nodule team.

The American Lung Association has a variety of lung cancer screening resources for both patients and healthcare professionals. 

• Visit Lung.org/lcscreening for comprehensive information on eligibility, screening centers, insurance coverage, and educational materials.
• Check out our Saved By The Scan campaign and help patients understand their risk: lung cancer risk quiz.
• Call 844-ALA-LUNG to speak one-on-one with a a Lung Health Navigator at or connect with a specialist online.