The 2021 United States Preventive Services Task Force (USPSTF) Recommendation Statement for Screening for Lung Cancer reduced the starting age for screening from 55 to 50 years and the minimum cumulative smoking exposure from 30 to 20 pack-years relative to the 2013 recommendation. Both recommended strategies include discontinuing screening at age 80 years and at a maximum of 15 years since smoking cessation. More information can be found here.

According to a presentation at the CHEST 2021 Annual Meeting, researchers suggested that expanding eligibility for lung cancer screening in the United States can potentially improve survival rates, especially among African Americans. Researchers conducted a retrospective cohort study of patients with lung cancer in which researchers sought to assess the potential impact of change linked to the July 2020 USPSTF proposal to loosen screening criteria for lung cancer so that individuals aged 50 years and older with a 20 pack-year or greater history of smoking would become eligible for screening. Researchers concentrated on the effect this change would likely have on women and individuals of various ethnic/racial minorities.

The investigators concluded that the original USPSTF lung cancer screening criteria benefit only a small subset of individuals with the disease. They also noted that future research is necessary to explore whether removing the need for tobacco-use criteria altogether would be linked to an even higher success rate in the diagnosis of early lung cancer, particularly among women and in minorities with an elevated prevalence of developing lung cancer not related to smoking.

According to a study published in JAMA, the 2021 USPSTF recommendation on lung cancer screening is cost-effective relative to the 2013 recommendation but not when compared with alternative screening strategies.

A recently published systematic review and meta-analysis in the Journal of Thoracic Oncology indicates that while screening for lung cancer reduces mortality, patient adherence to screening intervals in the U.S. is suboptimal. The meta-analysis included 21 studies. The pooled adherence rate was 57% for defined adherence, which consisted of an annual incidence screen performed within 15 months among 6,689 patients and 65% for anytime adherence among 5,085 patients.

The authors indicated that overall rates of adherence to Lung Imaging Reporting and Data System (Lung-RADS) recommended screening intervals in clinical practice is low compared with the over-90% adherence observed in the National Lung Screening Trial, adversely affecting the mortality benefits of lung cancer screening. The authors also indicated that greater adherence rates were observed in patients with Lung-RADS 3 (risk for lung cancer, 1%-2%) and 4 (risk, >5%) than Lung-RADS 1 and 2 (risk, <1%; P <.05). They also suggested that tailored interventions based on Lung-RADS categories may be advantageous.

The authors concluded that the low adherence rates witnessed in the clinical practices could be explained by patient characteristics, insurance coverage, and interventions to ensure adherence, among other factors. Based on their findings, they also proposed that standardized reporting of adherence rates to lung cancer screening be required to recognize interventions to expand adherence.

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