Lung cancer is currently the leading cause of death from cancer in the United States. Last year, more than 135,000 people died from lung cancer, and more than 220,000 new cases were diagnosed. Recently, the United States Preventive Services Task Force (USPSTF) expanded eligibility for lung cancer screening with low-dose computed tomography (LDCT) to begin at a younger age and a lesser pack-year history of smoking. The USPSTF now recommends persons aged 50 to 80 with a 20 pack-year smoking history who currently smoke or who have quit within the last 15 years undergo annual LDCT screening.1

Previous Guidelines

The initial USPSTF lung cancer screening guidelines, released in 2013, recommended annual LDCT screening for persons aged 55 to 80 with a 30 pack-year history of smoking and who currently smoked or quit within the previous 15 years. Following the release of these guidelines, further research found that a significant reduction in risk of death from lung cancer is possible if screening begins at a lower age and fewer pack-year history of smoking.2


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Racial Disparities

The updated guidelines will also help improve the racial disparities discovered following the 2013 guideline release, especially for Black and Hispanic populations. Smoking habits and risks associated with smoking vary by racial group, yet previous guidelines did not fully encompass this. A study by Haiman et al determined that only 17% of the Black population were eligible for lung cancer screening compared with 31% of the White population, yet Black persons who smoke have a higher risk of developing lung cancer than White persons who smoke.1 In addition, it was found that the higher risk Hispanic and Latinx populations have a less pack-year smoking history that was not captured by the 2013 guidelines.3

Screening Concerns

Risks associated with lung cancer screening exist with the potential for false-positive results, which could lead to additional testing, procedures, incidental findings, and increased patient anxiety. Although one study demonstrated false-positive rates of 26.3% upon screening, the study did not use Lung-RADS diagnostic criteria, which are in use today. Had Lung-RADS been used, the false-positive rate would have been reduced to 12.8%. Despite the risks, lung cancer screening with LDCT has shown a 20% risk reduction in death from lung cancer and an increase in life-years gained.1

Implementing New Guidelines

Becoming familiar with the updated guidelines is important for clinicians. For patients who meet the new screening criteria, discussions between the provider and the patient should take place. The patient should be educated on the potential risks and benefits of lung cancer screening, and if they are agreeable, they should be referred for LDCT.

Patients should also be educated that screenings are recommended to be done annually, as long as no suspicious findings are discovered. Annual screening can be discontinued if a patient has completed 15 years of smoking cessation or has developed a condition that limits their life expectancy. Regardless of a patient’s decision on undergoing LDCT, smoking cessation should be discussed with any patient who is currently smoking.1

References

  1. US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325(10):962-970. doi:10.1001/jama.2021.1117
  2. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382(6)503-513. doi:10.1056/NEJMoa1911793
  3. Haiman CA, Steam DO, Wilkens LR, et al. Ethnic and racial differences in the smoking-related risk of lung cancer. N Engl J Med. 2006;354(4):333-342. doi:10.1056/NEJMoa033250