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USPSTF broadens eligibility criteria for lung-cancer screening

Reuters Health - 09/03/2021 - The U.S. Preventive Services Task Force (USPSTF) has revised its advice on lung-cancer screening, rendering more people eligible for screening.

The task force, chaired by Dr. Alex Krist of Virginia Commonwealth University, in Richmond, now recommends annual screening for lung cancer using low-dose computed tomography (LDCT) for adults aged 50 to 80 years who have a smoking history of 20 pack-years and currently smoke or have quit within the past 15 years.

This updated recommendation replaces the 2013 USPSTF recommendation, which advised annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.

As in the 2013 recommendation, the task force advises that annual screening should end 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.

The revised recommendations, published in JAMA, are based on a systematic review of the latest evidence on the benefits and harms of annual lung-cancer screening, including microsimulation modeling studies, to zero in on the best age to start and stop screening and in what populations.

These modeling studies, performed by Dr. Rafael Meza at the University of Michigan, in Ann Arbor, and colleagues, suggested that "LDCT screening for lung cancer compared with no screening may increase lung cancer deaths averted and life-years gained when optimally targeted and implemented," the authors write.

"Screening individuals at aged 50 or 55 years through aged 80 years with 20 pack-years or more of smoking exposure was estimated to result in more benefits than the 2013 USPSTF-recommended criteria and less disparity in screening eligibility by sex and race/ethnicity," they note.

In a phone interview with Reuters Health, Dr. Bernard Park, deputy chief of Clinical Affairs for the Thoracic Service at Memorial Sloan Kettering (MSK) Cancer, in New York City, and head of MSK's lung screening program, said the revisions "make sense" because they now include certain populations that are at higher risk for lung cancer, like those at a lower age and a lower tobacco exposure.

Unfortunately, said Dr. Park, "the people that are at risk for lung cancer are overwhelmingly not screened as there are a lot of barriers to screening. I don't know whether it's because of the stigma of tobacco abuse or whatnot, but it just doesn't have the same emphasis as other cancers like colorectal cancer or breast cancer or prostate cancer. Lung cancer is less common than those cancers, yet it's much more lethal."

The authors of an editorial in JAMA note the revised recommendations make 14.5 million adults eligible for screening, an increase of 81% (6.4 million adults) from the 2013 recommendations.

"Given the limited uptake of lung cancer screening (range 6%-18%) and concerns regarding sex, race, and ethnicity-based disparities in eligibility that occurred with the 2013 recommended criteria, it remains to be seen if the revised 2021 recommended criteria can be implemented and will reduce inequities in accessing screening," write Dr. Louise Henderson and co-authors with the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill.

"The 2021 USPSTF recommendation statement represents a leap forward in evidence and offers promise to prevent more cancer deaths and address screening disparities. But the greatest work lies ahead to ensure this promise is actualized," they conclude.

In a separate editorial in JAMA Oncology, Dr. Mayuko Ito Fukunaga of the University of Massachusetts Medical School, in Worcester, and colleagues also raise implementation concerns.

"Increasing the number eligible without increasing the means to do so will very likely perpetuate the problem of limited implementation. It is more necessary than ever, and indeed the USPSTF calls for more research, to identify effective strategies to reach and engage the target population and ensure implementation of each core element for high-quality lung cancer screening," they write.

"We hope that by the next iteration of the USPSTF statement on lung cancer screening, there will be enough evidence to include recommendations on effective implementation strategies to disseminate high-quality lung cancer screening to all who may benefit," they conclude.

SOURCE: https://bit.ly/38qGp67, https://bit.ly/2OjSzXw, https://bit.ly/3emZXvX, and https://bit.ly/3cffoUq JAMA, March 9, 2021.

By Megan Brooks

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