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Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network\u2010validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit\u2010to\u2010radiation\u2010risk ratios from LCS and follow\u2010up examinations. The GDG also examined disease burden data from the National Cancer Institute\u2019s Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50\u201380\u00a0years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80\u00a0years who are in good health. The ACS recommends annual LCS with low\u2010dose computed tomography for asymptomatic individuals aged 50\u201380\u00a0years who currently smoke or formerly smoked and have a \u226520 pack\u2010year smoking history (\n                    <jats:italic>strong recommendation<\/jats:italic>\n                    ,\n                    <jats:italic>moderate quality of evidence<\/jats:italic>\n                    ). Before the decision is made to initiate LCS, individuals should engage in a shared decision\u2010making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.\n                  <\/jats:p>","DOI":"10.3322\/caac.21811","type":"journal-article","created":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T10:00:27Z","timestamp":1698832827000},"page":"50-81","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":264,"title":["Screening for lung cancer: 2023 guideline update from the American Cancer Society"],"prefix":"10.3322","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5510-7224","authenticated-orcid":false,"given":"Andrew M. 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