The U.S. Preventive Services Task Force (USPSTF) recently expanded its recommendation to call for annual lung cancer screening of more patients.
The Task Force now recommends annual low-dose computed tomography (CT) screening for adults ages 50 to 80 years who have a 20 pack-year smoking history and either currently smoke or quit within the past 15 years. 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. This B recommendation represents a change from 2013 when the USPSTF recommended annual screening for those ages 55 to 80 years who have a 30 pack-year history and currently smoke or quit within the past 15 years.
The recommendation was based on a new systematic review that looked at seven randomized controlled trials assessing the accuracy, benefits, and harms of low-dose CT screening for lung cancer (including the NLST and NELSON trials). The Task Force also commissioned collaborative modeling studies that used the Cancer Intervention and Surveillance Modeling Network to provide information about the optimal ages and intervals for screening and relative harms and benefits of different screening strategies as well as effects on different patient subgroups, including by race and sex. The recommendation was published by JAMA on March 9.
Accompanying editorials were published in several journals. Several mentioned the potential of the expanded recommendation to reduce existing inequities in lung cancer screening. As an editorial in JAMA explained, “the 2021 recommendations are expected to result in higher relative increases in eligibility for women vs men and non-Hispanic Black, Hispanic, American Indian, and Alaska Native populations vs non-Hispanic White and Asian populations.”
However, an editorial in JAMA Surgery cautioned that the new recommendation would not be sufficient to ensure widespread screening. “Our failure is that only 5% to 6% of the roughly 9 million individuals in the US who are eligible, and for whom screening is recommended, ever undergo screening. Patient-and clinician-specific barriers to lung cancer screening are formidable and unless the root causes impeding uptake, adherence, and compliance are addressed, disparities will inevitably persist.”
An editorial in JAMA Network Open highlighted some of the barriers to screening, including insurance coverage, while one in JAMA Oncology reviewed some of the data on which the new recommendation was based.