Updated lung cancer screening guidance broadens eligibility, but challenges remain
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The U.S. Preventive Services Task Force updated its guideline for lung cancer screening in 2021, marking the first change to the recommendation since 2013.
The update included changes to screening criteria, such as lowering the minimum screening age from 55 to 50 years and reducing smoking history from 30 to 20 pack-years.
In addition to reducing racial disparities and promoting a more accessible and equitable guideline, the USPSTF aimed to provide more life-years for patients by promoting earlier screening.
Healio spoke with Peter J. Mazzone, MD, MPH, director of the Lung Cancer Program and Lung Cancer Screening Program at the Cleveland Clinic Cancer Center Respiratory Institute, about how the changes to the guidelines have affected the number of patients being screened, improvements in patient outcomes and how specialists should continue to prepare for the effects of the updated guideline.
Healio: What prompted the updates to the USPSTF lung cancer screening guidance?
Mazzone: The USPSTF periodically reviews their guidance. There was substantial new information since their last recommendations. One particular study, the NELSON trial, confirmed the benefit of lung cancer screening while enrolling individuals at a younger age and with a lower smoking history than the National Lung Screening Trial had. This, combined with modeling performed for the USPSTF and a goal for their criteria to lead to more equity in access to screening and more life-years gained by screening, led to the updated guidance.
Healio: How will these updates improve patient outcomes?
Mazzone: A broader group of at-risk individuals are now eligible for lung cancer screening, extending this service to around 80% more people than with the prior criteria. The new criteria also lead to greater equity in the eligibility criteria across race and ethnicity.
Healio: Are there any concerns regarding the new guidance?
Mazzone: The new criteria expand the eligible group to some individuals who have an overall lower risk of lung cancer. Avoiding harms from screening to maintain a favorable balance of benefit to harms becomes even more important. Screening programs must also increase their capacity to see and track more people.
Healio: How will the updates affect oncologists in clinical practice?
Mazzone: The teams that lead lung cancer screening programs at any institution (often pulmonologists and radiologists, but partnering with primary care and oncology providers) will need to prepare for the increase in screening patient volumes. The hope would be that providers see more early-stage and fewer late-stage cancers.
Healio: What areas still need to be addressed?
Mazzone: There are still challenges with getting everyone who is eligible to be screened scheduled for a screening. Many patients do not return for their annual exams. Despite the broadened criteria, many individuals who develop lung cancer are still not eligible for screening. All of these issues are being worked on by the screening community and may be a part of future updates.
References:
- Potter AL, et al. Lancet Respir Med. 2021;doi:10.1016/S2213-2600(21)00210-1.
- Ritzwoller DP, et al. JAMA Netw Open. 2021;doi:10.1001/jamanetworkopen.2021.28176.
- USPSTF. Lung cancer: Screening. https://uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening. Published March 9, 2021. Accessed March 2, 2022.
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