Author: By Lynda Williams, Senior medwireNews Reporter
medwireNews: The US Preventive Services Task Force (USPSTF) has updated the Recommendation Statement guiding use of low-dose computed tomography (LDCT) screening for lung cancer in smokers.
The USPSTF advice now states that LDCT should be performed annually from age 50–80 years for current smokers with a 20 pack–year or greater smoking history and those who have quit smoking in the past 15 years.
This extends the targeted age group from the previously recommended range of 55–80 years and reduces the smoking exposure from 30 pack–years, report Alex Krist, Virginia Commonwealth University in Richmond, USA, and fellow USPSTF task force members in JAMA.
The advice is based on the findings of a modelling study, also published in JAMA, indicating that these changes are likely to “result in more benefits than the 2013 USPSTF-recommended criteria and less disparity in screening eligibility by sex and race/ethnicity”, explain Rafael Meza, from the University of Michigan in Ann Arbor, USA, and co-authors.
LDCT strategies using a 20 pack–year threshold were estimated to prevent 469–558 deaths per 100,000 individuals alive at age 45 years versus 381 per 100,000 with a 30 pack–year cutoff, resulting in 6018–7596 versus 4882 life–years gained per 100,000.
However, the lower exposure threshold was also associated with a higher rate of false-positive examinations (1.9–2.5 vs 1.9 per person screened in 100,000 population), lung cancer overdiagnosis (83–94 vs 69 per 100,000) and radiation-related lung cancer deaths (29.0–42.5 vs 20.6 per 100,000), the investigators say.
The balance of benefits and harms associated with LDCT screening in high-risk smokers was further assessed in the linked evidence report and systematic review assessing the benefits and harms, also reported in JAMA, by Daniel Jonas, from the University of North Carolina at Chapel Hill, USA, and co-workers.
Of the seven randomised trials assessed, only the National Lung Screening Trial (NLST) and the NELSON trial were deemed “adequately powered to assess for lung cancer mortality benefit”, they say. The studies’ respective strategies of three and four annual rounds of screening were found to be effective at reducing lung cancer death rates, while the NLST protocol also reduced all-cause mortality risk compared with chest radiography.
In an opinion published in JAMA Oncology, Christopher Slatore, from VA Portland Health Care System in Oregon, USA, and co-authors estimate that the update to the USPSTF recommendations will increase the proportion of the US population eligible for LDCT screening from 14.1% to 22.6%.
Noting that the uptake of lung cancer screening has been “low and slow” despite Medicare and Medicaid coverage, they suggest that increasing eligibility without further improving access “will very likely perpetuate the problem of limited implementation.”
The commentators therefore conclude: “It is more necessary than ever, and indeed the USPSTF calls for more research, to identify effective strategies to reach and engage the target population and ensure implementation of each core element for high-quality [lung cancer screening].”
References
US Preventive Services Task Force. Screening for lung cancer. US Preventive Services Task Force recommendation statement. JAMA 2021;325: 962–970. doi:10.1001/jama.2021.1117
Meza R, Jeon J, Toumazis I, et al. Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography. Modeling study for the US Preventive Services Task Force. JAMA 2021;325:988–997. doi:10.1001/jama.2021.1077
Jonas DE, Reuland DS, Reddy SM, et al. Screening for lung cancer with low-dose computed tomography. Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 2021;325: 971–987. doi:10.1001/jama.2021.0377
Fukunaga MI, Wiener RS, Slatore CG. The 2021 US Preventive Services Task Force Recommendation on Lung Cancer Screening. The more things stay the same… JAMA Oncol; Advance online publication 9 March 2021. doi:10.1001/jamaoncol.2020.8376
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