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March 10, 2021

New guidelines nearly double the number of Americans eligible for no-cost lung cancer screenings

Daily Briefing

    The U.S. Preventive Services Task Force (USPSTF) on Monday finalized new recommendations that nearly double the number of Americans eligible for no-cost lung cancer screenings and increase screening eligibility among female and Black patients.

    Our take: Addressing racial health disparities in cancer screening

    Lung cancer is the most fatal cancer in the US

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

    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.

    USPSTF expands lung cancer screening recommendations

    USPSTF's new recommendation updates the panel's 2013 guidelines, which qualified current or former smokers for screenings starting at age 55 if they had smoked a minimum of 30 "pack years"—that is, the number of years they smoked, multiplied by the average number of packs they smoked per day.

    Under the newly finalized recommendations, USPSTF lowered its recommended eligibility age for the screenings from 55 to 50 and lowered its pack-year eligibility threshold from 30 to 20. Like the 2013 recommendations, the new recommendations apply only to people who currently smoke or quit smoking within the last 15 years.

    USPSTF assigned screenings a "B recommendation," concluding "with moderate certainty that annual screening for lung cancer … has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking." Under the Affordable Care Act, insurers are required to cover preventive services that receive a "B" grade or higher from USPSTF without cost-sharing.


    The new recommendations will increase the number of Americans eligible for lung cancer screenings by 6.4 million to 14.5 million, the New York Times reports.

    According the panel, lowering the number of pack years needed to qualify for the screening also means more Black and female patients, who tend to develop lung cancer earlier than men despite smoking less, will eligible for screenings.

    Many experts welcomed the new recommendations.

    For example, John B. Wong, a task force member at Tufts Medical Center, called the new recommendations "a step in the right direction" because they make more Black and female patients eligible for screenings.

    However, some cancer specialists said the new guidelines alone will not improve access to screenings for patients.

    In an editorial in JAMA Surgery, Yolonda Colson and colleagues at Massachusetts General Hospital, wrote, "Unfortunately, lowering the age and pack-year requirements alone does not guarantee increased equity in lung cancer screening."

    Colson and her colleagues noted "formidable" barriers, including limited access to care, stand in the way of patients being screened for lung cancer.

    And other physicians raised concerns about false positives, which may occur when a screening flags a benign spot or growth and result in costly and invasive follow-up tests, including biopsies (McGinley, Washington Post, 3/9; Grady, New York Times, 3/9; Burton, Wall Street Journal, 3/9; Neergaard, Associated Press, 3/9; Owens, "Vitals," Axios, 3/11).


    Advisory Board's take

    The new guidelines are 'unquestionably great news.' (But they won't automatically save lives.)

    By Erin Lane and Ty Aderhold

    It's unquestionably great news that more people are becoming eligible for highly effective LDCT screening for lung cancer. But it's important to recognize that this change won't automatically translate to lives saved, cancers detected, or even patients screened. At best, 8 to 14% of currently eligible patients actually receive their recommended annual lung cancer screenings—compared to 66% for breast cancer screenings and 61% for colorectal cancer screenings, according to CDC.

    Why are lung cancer screening rates so low? There are a myriad of reasons, including financial barriers, stigma around and hesitancy from people who smoke, challenges identifying patients who meet eligibility criteria, and limited access for patients. Further, studies have demonstrated that black patients are less likely to receive a LDCT than white patients, even after controlling for eligibility and risk factors.

    These new guidelines address only one of those barriers: cost. If lung screening programs don't improve upon their historical outreach and operations methods, then it's likely that younger, more affluent, white, male patients will see the highest uptick in screening rates, potentially widening existing inequities.

    For actionable strategies to overcome this challenge, read our take on addressing racial health disparities in lung cancer screening. Among the steps to take:

    • Better identify the specific barriers faced by patients of color and women in your community;
    • Design programs to overcome those specific patient barriers and increase access; and
    • Address bias throughout the screening process.

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