US Task Force Advises Annual Lung Screening For High-Risk Older Adults

The US Preventive Services Task Force updates its recommendations for low-dose computed tomography lung cancer screening

medwireNews: The US Preventive Services Task Force (USPSTF) has concluded that adults aged 55 to 80 years with a 30 pack–year smoking history should undergo annual screening with low-dose computed tomography.

The statement, which appears in the Annals of Internal Medicine, stresses that the moderate net benefit obtained from annual screening depends on restricting screening to this high-risk group, and resolving most false-positive results without resorting to invasive procedures.

The evidence for benefit is limited to patients who currently smoke or have been regular smokers within the past 15 years.

Therefore, screening should be discontinued from 15 years after a patient quits, or if they develop a condition that is life-limiting or would prevent them from undergoing lung surgery.

These recommendations are based on the best-case scenario from a comparative modelling study using published data, conducted specifically for the USPSTF. The authors Harry de Koning, from Erasmus Medical Center in Rotterdam, the Netherlands, and colleagues, found that annual screening within these criteria would result in 50% of cancers being detected at an early stage and a 14% reduction in lung cancer mortality, requiring 575 screening examinations for each lung cancer death prevented.

In a 100,000-member cohort, of whom 19,300 would be eligible for screening at some point during their lives, screening would result in 497 fewer lung cancer deaths, with these people each gaining an average of 10.6 life–years. However, this assumes 100% adherence to screening, and the benefits would come at the cost of 67,550 false-positive results, 910 surgeries or biopsies for benign tumours and 190 overdiagnosed tumours (3.7% of all cases).

In an editorial accompanying the study, Frank Detterbeck, from Yale University School of Medicine in New Haven, Connecticut, USA, and Michael Unger, from Fox Chase Cancer Center in Philadelphia, Pennsylvania, USA, welcome the recommendation, given that lung cancer causes more deaths in the USA than the next three most lethal cancer types combined, but is the only one without a screening programme.

But they caution: “The USPSTF recommendation involves more than performing a scan and having a radiologist interpret it.”

The editorialists outline a number of issues, such as who should evaluate and put forward patients for screening, and how to involve and ensure adherence from the highest-risk people, who are often the least interested in undergoing screening. Achieving the potential benefit–risk ratio may also require offering counselling to people who desire screening despite not being at high risk, they add.

They ask: “Is the health care system willing to support what the USPSTF is recommending?”

References

Moyer VA. Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013 Dec 31. doi: 10.7326/M13-2771. [Epub ahead of print]

de Koning HJ, Meza R, Plevritis SK, et al. Benefits and Harms of Computed Tomography Lung Cancer Screening Strategies: A Comparative Modeling Study for the U.S. Preventive Services Task Force. Ann Intern Med. 2013 Dec 31. doi: 10.7326/M13-2316.  [Epub ahead of print]

Detterbeck FC, Unger M. Screening for Lung Cancer: Moving Into a New Era. Ann Intern Med. 2013 Dec 31. doi: 10.7326/M13-2904. [Epub ahead of print]

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