Updated screening guidance
Low-dose CT is the recommended test for people at increased risk who do not have lung-cancer symptoms.
Merrimack Thoracic & Esophageal Surgery can help determine whether screening is appropriate, coordinate the scan, and guide the next step when a result is abnormal.
Discuss screening or an abnormal scanAnnual low-dose CT
Who should consider lung-cancer screening?
Current recommendations and insurance coverage are not identical. A pack-year means smoking an average of one pack of cigarettes per day for one year. One pack daily for 20 years—or two packs daily for 10 years—equals 20 pack-years.
| Source | Who it includes |
|---|---|
| USPSTF | Annual low-dose CT for adults ages 50 through 80 with at least 20 pack-years who currently smoke or quit within the past 15 years. Screening stops when health substantially limits life expectancy or the ability or willingness to undergo curative treatment. |
| American Cancer Society | Annual low-dose CT for adults ages 50 through 80 with at least 20 pack-years who currently or formerly smoked. The guideline does not use years since quitting as an eligibility cutoff. |
| Medicare | Coverage for eligible beneficiaries ages 50 through 77 who are asymptomatic, have at least 20 pack-years, currently smoke or quit within 15 years, receive an appropriate order, and complete the required initial counseling and shared-decision visit. |
Screening is generally appropriate only when a person's overall health and life expectancy make further evaluation and potentially curative treatment reasonable, and the person is willing to undergo that treatment if cancer is found.
Screening is for people without symptoms
Screening is different from diagnostic evaluation. Coughing blood, unexplained weight loss, a new persistent cough, chest pain, or worsening shortness of breath requires medical assessment rather than a routine screening scan. An existing lung nodule or a previous lung cancer may require diagnostic imaging or cancer surveillance instead.
The recommended screening test is an annual low-dose CT of the chest—not a chest X-ray and not a blood test. Blood-based testing is discussed separately on our liquid-biopsy page.
What happens after the scan?
Screening facilities generally use the American College of Radiology's Lung-RADS system to classify findings and recommend follow-up. A CT finding does not by itself establish cancer, and many abnormal screening scans are ultimately benign.
Depending on a finding's appearance, size, and growth, the next step may be:
- Return to annual screening
- A repeat CT at a shorter interval
- A diagnostic chest CT
- PET/CT in selected cases
- Bronchoscopy or needle biopsy
- Thoracic surgical evaluation
Comparison with earlier scans is often critical. Please arrange for our office to receive the actual images, not only the written report.
Benefits and limitations
For appropriately selected patients, annual low-dose CT reduces the risk of dying from lung cancer. It can also identify benign nodules or unrelated abnormalities, lead to additional scans or procedures, expose patients to a small amount of radiation, miss some cancers, or detect a cancer that might never have caused harm. These tradeoffs are part of shared decision-making.
Screening is not a substitute for stopping smoking. Evidence-based help is available through Smokefree.gov and 1-800-QUIT-NOW.
Independent, surgeon-led care
A clear next step after an abnormal scan
We review current and prior imaging, explain the finding in the context of your risk, and distinguish nodules that can be monitored from those that need additional evaluation. When appropriate, we coordinate imaging, biopsy, or surgery with radiologists, pulmonologists, medical oncologists, and radiation oncologists across the Merrimack Valley and Southern New Hampshire.
A referral to a thoracic surgeon does not mean that you have cancer or need an operation. The purpose is to obtain the right evaluation without unnecessary delay or unnecessary procedures.
Sources and further reading
Sources reviewed September 12, 2026. This is a brief educational summary, not an individual recommendation. Guidelines and coverage rules change.