Smoking criteria limits eligibility for lung cancer screening in NSCLC patients

SEATTLE — Less than one-third of patients with non-small cell lung cancer treated at a California medical center would have been eligible for lung cancer screenings based on several existing guidelines, according to data presented at the American Association for Thoracic Surgery Annual Meeting.

Geena Wu, MD, a fellowship resident at the City of Hope National Medical Center in Duarte, California, and colleagues identified 2,030 patients with NSCLC treated between 1994 and 2014. They sought to determine the proportion of cases that may have been detected by screening with low-dose computed tomography in patients who met lung cancer screening criteria from various health organizations, including the U.S. Preventive Services Task Force. The USPSTF recommends lung cancer screening in patients aged 55 to 80 years who have a minimum 30 pack-year history of smoking, and if they are former smokers, those who quit within 15 years.

Geena Wu

The researchers gathered smoking status, pack-years and number of years since cessation from patients treated at the medical center. Data indicated that 31% of patients were current smokers, 43% were former smokers, and 26% were never-smokers.

Patients with early and later stages of NSCLC were more likely to be former smokers (43% and 41.2%, respectively) than never-smokers (26% and 29.7%).

Wu and colleagues said only 31.3% of the patients who were former smokers met USPSTF recommendations for lung cancer screening. Among current and former smokers, 76.9% were aged 55 to 80 years, they smoked a median of 40 pack-years, and 56.9% had a 30 pack-year or more smoking history.

Current smokers (67.5%) were more likely to meet screening criteria than former smokers (27%) (P < .0001).

Wu said if quit time and pack-year requirements were removed, the proportion of patients with NSCLC who would have met USPSTF criteria for lung cancer screening would have increased by 23%.

“Our data may not be generalizable to the rest of the country due to a high population of Hispanics and Asians as well as never-smokers in [California],” she said. “In addition, retrospective application of lung cancer screening criteria to patients who are already diagnosed with lung cancer limits our ability to make any determination if additional screening would have altered or provided benefit to patients’ disease course."

“We advocate that the critical assessment of current lung cancer screening criteria, especially the quit time maximum, is warranted. When additional data become available, organizations should come to a consensus on a uniform validated set of criteria for lung cancer screening.” – by Ryan McDonald

Reference:

Wu G, et al. Abstract 106. Presented at: the American Association for Thoracic Surgery Annual Meeting; April 25-29, 2015; Seattle.

Disclosure: Wu reports no relevant financial disclosures.