美国和加拿大建议在某些高风险个体中进行人群筛查。美国国家肺筛查试验 (National Lung Screening Trial, NLST) 由美国国家癌症研究所赞助,对超过 53,000 例吸烟者或既往吸烟者进行随机分配,并让其连续 3 年每年一次接受胸部 X 线或低剂量螺旋 CT 筛查,结果显示肺癌的死亡率减少了 20%。[93]Aberle DR, Adams AM, Berg CD, et al; The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409.http://www.nejm.org/doi/full/10.1056/NEJMoa1102873#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/21714641?tool=bestpractice.com 美国多个专业机构建议进行癌症筛查,但明确建议是在美国预防服务工作组 (US Preventive Services Task Force, USPSTF) 的分析之后。这个工作组审查了 CT 筛查的证据,建议扩大 NLST 采用的年龄范围,因此对 55 至 80 岁、至少有 30 包-年吸烟史的当前吸烟者或在之前 15 年内戒烟的患者提供筛查。[94]Moyer VA. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160:330-338.http://annals.org/article.aspx?articleid=1809422http://www.ncbi.nlm.nih.gov/pubmed/24378917?tool=bestpractice.com[95]Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012;307:2418-2429.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709596/http://www.ncbi.nlm.nih.gov/pubmed/22610500?tool=bestpractice.com[96]Detterbeck FC, Mazzone PJ, Naidich DP, et al. Screening for lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(suppl):e78S-e92S.http://journal.chestnet.org/article/S0012-3692(13)60290-1/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/23649455?tool=bestpractice.com以上标准得到美国和加拿大医疗卫生资助机构同意。