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Clinician Article

Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement.



  • Krist AH
  • Davidson KW
  • Mangione CM
  • Barry MJ
  • Cabana M
  • Caughey AB, et al.
JAMA. 2021 Mar 9;325(10):962-970. doi: 10.1001/jama.2021.1117. (Review)
PMID: 33687470
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 6/7
  • Respirology/Pulmonology
    Relevance - 6/7
    Newsworthiness - 6/7
  • Oncology - Lung
    Relevance - 4/7
    Newsworthiness - 5/7

Abstract

Importance: Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228?820 persons were diagnosed with lung cancer, and 135?720 persons died of the disease. The most important risk factor for lung cancer is smoking. Increasing age is also a risk factor for lung cancer. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment.

Objective: To update its 2013 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the accuracy of screening for lung cancer with low-dose computed tomography (LDCT) and on the benefits and harms of screening for lung cancer and commissioned a collaborative modeling study to provide information about the optimum age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies compared with modified versions of multivariate risk prediction models.

Population: This recommendation statement applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

Evidence Assessment: The USPSTF concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking.

Recommendation: The USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued 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. (B recommendation) This recommendation replaces the 2013 USPSTF statement that recommended 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.


Clinical Comments

General Internal Medicine-Primary Care(US)

This article expands the Preventive Task Force lung cancer screening for patients 50 to 80 (was 55 to 80) and with a history of 20 pack-years (was 30). They argue that it will lead to even fewer lung cancer deaths and more life-years. They admit, however, that the total mortality is either not increased or only minimally increased depending on the study.

Oncology - Lung

For oncologists who do not defer to primary care for cancer screening, this revision of the USPSTF's recommendations will be of interest. Age range increased to 50-80 years and smoking history decreased to 20 pack-years. The maximum interval since smoking cessation has remained the same at 15 years.

Respirology/Pulmonology

Updated recommendations broaden the criteria for LDCT lung cancer screening. Should include more groups currently excluded from the previous guidelines. Questions remain as to cost as well as small but real increased risk for radiation induced-mortality.

Respirology/Pulmonology

This updated guideline finds evidence for expanding the eligibility criteria for lung cancer screening to slightly younger patients with less smoking history. This will have a broad effect on clinical practice.

Respirology/Pulmonology

Very important update for both primary care physicians and specialists. Good analysis of the potential harms of false-positives and impact of LungRads in evaluating screened patients.

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