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2 Both the CMS and the USPSTF state that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. 2 Of note, the NCCN Lung Cancer Screening Guidelines state that limiting use to the NLST criteria is arbitrary and nave, because the NLST only used age and smoking history for inclusion criteria and did not consider other well-known risk factors for lung cancer. 24 Private insurance generally follows USPSTF guidelines and has been mandated by the ACA to offer lung cancer screening benefits for eligible patients

Virginia tobacco leaves mature at different rates while on the stalk, so harvesting requires picking the bottom leaves first, followed by the middle ones, and then the top ones

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