Many patients at high risk for lung cancer would not meet the current US Preventive Services Task Force (USPSTF) screening criteria, according to research published in the Journal of Thoracic Oncology.1
The researchers suggest including people who are younger than 81 years, have a smoking history of 30 or more pack-years, and have quit for 15 to 30 years could increase the number of cases without increasing overdiagnosis or the number of false-positives, thereby save more lives.
The study used two prospective cohorts and one retrospective cohort to estimate the impact of using different screening eligibility criteria and identify other subpopulations that may be at high-risk.
The hospital cohort (prospective) included 5988 patients with primary lung cancer diagnosed between 1997 and 2011; the community cohort (prospective) included 850 defined-community residents; and the population of Olmsted County, Minnesota, which was observed for 28 years (1984-2011) served as the retrospective cohort.
Results showed the largest subgroup excluded by the criteria are former smokers with a smoking history of 30 or more pack-years, 15 to 30 quit-years, and were 55 to 80 years old. This group constituted the 12% of the hospital cohort and 17% of the community cohort.
Expanded criteria suggested by the study would increase the CT examinations by 19% thereby detecting 16% more cases compared with the current USPSTF criteria. False-positive results, overdiagnosis, and radiation-related lung cancer deaths would increase by 0.6%, 0.1%, and 4.0%, respectively.
1. Yang P, Wang Y, Wampfler JA, et al. Trends in subpopulations at high risk for lung cancer. J Thorac Oncol. 2016;11(2):194-202.