Lung cancer screening — CCFP MCQ

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HardPreventive care and screeningLung cancer screeningCCFP

A 72-year-old man smoked 35 pack-years and quit 8 years ago. He has no lung cancer symptoms and asks whether he should have a chest x-ray every year. He lives near a centre with organised low-dose CT screening. What is the most appropriate screening/preventive measure?

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Correct answer: C — Discuss low-dose CT screening through an organised programme rather than chest x-ray

Explanation lettering: E = shown as C · C = shown as D · D = shown as E

The CTFPHC (incorporated in CFPC preventive care guidance and CMAJ recommendations) endorses low-dose CT screening for adults aged 55–74 years with ≥30 pack-year history who currently smoke or quit within 15 years. This patient meets all criteria: age 72, 35 pack-years, quit 8 years ago. Organized LDCT programmes with diagnostic expertise are the gold standard (not chest x-ray, which offers no mortality benefit). Option A is incorrect because chest x-ray screening is explicitly not recommended. Option C is wrong: former smokers within 15 years of cessation remain eligible. Options B (sputum cytology) and D (tumour markers) lack evidence and are not part of current Canadian screening guidance. Option E correctly advises discussion of LDCT through an organized centre, aligning with best current evidence and Canadian guidelines.

Reference: Canadian Task Force on Preventive Health Care (CTFPHC). Recommendations on screening for lung cancer. CMAJ. 2016; and CFPC Preventive Care Checklist Form Update. 2020. https://www.cmaj.ca/content/188/6/425