1735P - Impact of revised US Preventive Services Task Force (USPSTF) 2021 lung cancer screening guideline on long-term cancer survivors in the United States

Background

Among long-term cancer survivors (i.e., survived > 5 years since most recent cancer diagnosis) with a non-lung primary cancer, second primary lung cancer (SPLC) has the highest incidence (19%) and mortality (32%) rate among all secondary primary cancers. There are currently no separate screening guidelines for SPLC, though most providers have adopted the general USPSTF recommendation for lung cancer screening (LCS) in cancer survivors. We aimed to assess the differences in LCS eligibility rates among long-term cancer survivors under the USPSTF 2013 vs revised 2021 guidelines.

Methods

Smokers aged 50-79 years were selected from the 2017-2021 US Behavioral Risk Factor Surveillance System data. We assessed the eligibility of LCS using USPSTF 2013 criteria: current or former smokers (quit ≤ 15 years), 55-80 years of age and ≥ 30 pack-year smoking history, and the revised 2021 criteria (expanding age to 50-80 and pack-year to 20) in long-term cancer survivors. Weighted chi-square tests were used with SAS (9.4).

Results

A weighted total of 17,544,768 smokers were selected (2.7% were cancer survivors). The LCS eligibility rate of long-term cancer survivors using the 2013 criteria was similar to the non-cancer survivors (21.1% vs 22.4%; p=0.62) but lower when using the 2021 criteria (31.5% vs 38.0%; p=0.03). The 2021 criteria increased eligibility for long-term cancer survivors across all groups (Table). However, the degree of increase in eligibility rate in cancer survivors was lower than in non-cancer survivors.

Table: 1735P

*P-value compares non-cancer survivors vs cancer survivors in the change of eligibility rate from 2013 to 2021 USPSTF criteria.

Conclusions

The increase in eligibility from the revised 2021 USPSTF appears to be less in long-term cancer survivors than in non-cancer survivors. Cancer survivors are facing a significant burden from SPLC due to their prior diagnostic tests and treatments (e.g., chest irradiation), genetic susceptibility, and shared risk factors. Tailored LCS eligibility criteria are urgently needed in the growing cancer survivor population.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M.L. Hsu: Financial Interests, Institutional, Advisory Board: Regeneron, MJH Life Sciences. A. Dowlati: Financial Interests, Institutional, Research Grant: EMD Serono, Tesaro, Roche, Regeneron, Vertex, Eli Lilly, Bayer, Takeda, Ipsen, United Therapeutics, Mirati, Bristol Myers Squibb, Incuron; Financial Interests, Personal and Institutional, Research Grant: AbbVie, AstraZeneca, Millenium, Seattle Genetics; Financial Interests, Personal, Financially compensated role: Ariad. All other authors have declared no conflicts of interest.