July 9, 2020

Proposed new lung cancer screening guidelines would increase eligibility of women, Black patients

Daily Briefing

    The U.S. Preventive Services Task Force (USPSTF) on Tuesday released draft guidelines that would double the number of Americans eligible for lung cancer screenings and increase screening eligibility among female and Black patients.

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    Overall, Michael Barry—a physician at Massachusetts General Hospital and task force member—said the new recommendations, if finalized, would make about 15 million Americans eligible for the screening.

    Current guidelines apply only to certain current or former smokers ages 55 or older

    Lung cancer, which is responsible for more than 135,000 deaths per year, is the most fatal cancer in the United States. Smoking and age are two of the biggest risk factors for the disease. According to STAT News, smokers are about 20 times more likely than nonsmokers to develop lung cancer.

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    The condition is usually diagnosed in late stages, but research shows that annual CT scans can reduce the risk of death among patients of a certain age and smoking status, the Associated Press reports.

    USPSTF's current guidance, which the task force last updated in 2013, qualifies current or former smokers for screenings, starting at age 55, who have smoked a pack a day for a minimum of 30 years or a comparable amount.

    Newly proposed guidelines could increase access to lung cancer screenings

    On Tuesday, USPSTF released draft guidelines that would improve access to the potentially life-saving screenings.

    Under the draft guidelines, USPSTF would lower its recommended eligibility age for the screenings from 55 to 50 and lower its eligibility threshold related to "pack years"—the number of years a person smoked a pack of cigarettes per day—from 30 to 20.

    The task force proposed the updated draft guidelines after reviewing new research that showed people with a high-risk smoking history who are between ages 50 and 80 are just as likely to benefit from the screenings as older smokers.

    The draft guidelines are open to the public for comment until Aug. 3. If the guidance is finalized, insurers would have to cover the screenings for eligible individuals without cost sharing, the AP reports.  

    Implications

    Health experts lauded the draft guidelines.

    USPSTF "had commissioned a systematic review of the literature, as well as some modeling studies from the cancer intervention and surveillance modeling network to really try to come up with some evidence-based modifications," said Bernard Park, deputy chief of thoracic surgery at Memorial Sloan Kettering Cancer Center.

    And according to the task force, the increased eligibility would make more women and more Black Americans qualify for screenings.

    Mara Antonoff, an assistant professor of thoracic and cardiovascular surgery at MD Anderson Cancer Center, said lowering the number of pack years needed to qualify for the screening will benefit women especially, since "[w]omen seem to develop lung cancer with lesser exposure than men."

    In addition, Antonoff said changing the age criteria will benefit Black people who "have a tendency to develop lung cancer at earlier ages, on average" than white people.

    "Making screening for lung cancer available to people who have smoked less over time will help doctors support the health—and potentially save the lives—of more of their African American and female patients," said John Wong, a physician at Tufts Medical Center and a member of the task force.

    However, Park added that while more people would qualify for the screening under the draft guidelines, getting patients to undergo the screenings may continue to be a challenge. According to USPSTF, only about 6% of eligible patients receive a lung cancer screening.

    "It's one thing to expand the theoretical pool of those [who] can be screened. The harder challenge is to actually get those patients screened," Wong said.

    Antonoff added that a lot of physicians are still unaware of the benefits of the screenings. "The education regarding lung cancer screening is a huge problem. It's generally lacking," she said. But "[l]ung cancer screening is very important to early diagnosis and much earlier treatment of lung cancer. By exposing more individuals who are at high risk to the opportunity to be screened means we can save more lives" (Sandoval, NBC News, 7/7; AP/New York Times, 7/7; Spinelli, STAT News, 7/7).

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