Selecting the best candidates for lung cancer screening

The Center for Medicare and Medicaid Services (CMS) recently decided to reimburse for annual lung cancer screening with low-dose computed tomography (LDCT) among personswhomeet the inclusioncriteria for theNationalLungCancer Screening Trial (NLST).1 Those who have smoked for more than30pack-years, continue to smoke,orquitwithin the past 15 years and are 55 to 77 years old will be eligible for free annual LDCT screening—roughly 6% of the US population older than 40 years.2 For the initial LDCT screening, a “lung cancer screening counseling and shared decision-making visit” will be required. Counseling visits will be reimbursed annually thereafter but will not be required.What considerations should be included in shared decision making? The Teachable Moment published in this issue by Schneider andArenberg3 reminds us that lung cancer screening—likemostmedicaldecision-making—isagamble; that there are good bets and bad bets—and that the odds are stacked against some people who will be eligible for LDCT screening. Thinking hard about how to optimally select people to screen is critically important as we move forward with populationbased lung cancer screening programs.