The USPSTF has issued new age and smoking history criteria for those eligible to undergo lung cancer screening (Photo courtesy of University of Cincinnati)

USPSTF lowers age, expands access to lung cancer screening

March 10, 2021
by John R. Fischer, Senior Reporter
Current and former smokers should undergo annual lung cancer screenings starting at age 50, according to final guidelines issued this week by the U.S. Preventive Services Task Force.

The recommendation lowers the original age limit from 55 to 50 and redefines the definition of a heavy smoker as someone with a 30 pack-year history (one pack a day for 30 years) to a 20 pack-year history. Like the most recent 2013 version, the new guideline pertains to those who still smoke or have quit in the last 15 years and refers to those 80 or under.

“By screening people who are younger and who have smoked fewer cigarettes, we can save more lives and help people remain healthy longer,” said USPSTF member Dr. Michael Barry in a statement.

Lung cancer is the number one cause of death in the U.S., with more than 200,000 people diagnosed annually. Smoking is the leading cause, and the Task Force expects the new recommendations to nearly double the number of people eligible for lung cancer screening to 15 million people, reports the Washington Post.

The changes are expected to especially be helpful for Black people, who have a higher risk of lung cancer than white people despite smoking fewer cigarettes than white men. They also are seen as potentially lifesaving for women, who also smoke less than white men.

“Lung cancer kills more people each year than breast, colon and prostate cancers combined. Particularly with the expanded screening thresholds implemented nationwide, this cost-effective test can save more lives than any cancer-screening test in history,” said Dr. Debra Dyer, chair of the ACR Lung Cancer Screening Steering Committee, in a statement.

The guidance is a B recommendation, meaning that private insurers are required to cover it without levying a share of the cost on to the patient, as specified in the Affordable Care Act. The ACA mandates that private payers adopt updated USPSTF guidelines within one year. Medicare also tends to follow the group’s guidelines, according to the Washington Post.

The final recommendations are based on an updated evidence report and review of 223 previously published studies, reports CNN. They were first issued in a draft in 2020 that was open to public comment between July 7 and August 3. The aim is to increase the number of people undergoing low-dose CT screening for lung cancer, as only less than 15%, under the previous guidelines, did so each year.

While some physicians welcome the new guidelines, some are cautious, due to their not addressing risk factors beyond smoking, and because low-dose CT is known to produce false positives, which can lead to unnecessary testing. Another challenge to address is the implementation of lung cancer screenings into everyday practice.

“Research on implementation strategies are needed. For example, improving patient and provider knowledge and using reminders of eligible patients in the electronic medical record could increase the utilization of CT screening. Implementation of these practices is likely to reduce mortality related to lung cancer,” Dr. Robert Van Haren, assistant professor of surgery at the University of Cincinnati and a UC Health thoracic surgeon, told HCB News.

The best way of reducing the risk of death from lung cancer is to quit smoking and to stay smoke free afterward, according to the Task Force.

The final recommendation statement and corresponding evidence summary and modeling studies were published online in the Journal of the American Medical Association and on the Task Force website.