News July 10, 2020

Proposed Guidelines for Lung Cancer Screening Would Nearly Double Number of People Who Should Get Tested

More women and African Americans would be prompted by their clinicians to get screened for lung cancer under a new recommendation by the U.S. Preventive Services Task Force.
Screening for lung cancer.
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A new draft recommendation by a national panel of health-care experts would nearly double the number of Americans eligible for lung cancer screenings — and should result in more women and African Americans getting screened for the deadliest cancer in the United States.

The draft recommendation by the U.S. Preventive Services Task Force lowers the age to start screening and reduces the amount of smoking history that makes someone eligible for testing.

“The new recommendation is based on new, high-quality evidence that shows benefit from screenings in a broader group of people,” said Stanford Health Policy Director Douglas K. Owens, who is the immediate past chair of Task Force. “The additional evidence led us to expand the group in which we recommend screening.”

Lung cancer is the leading cause of cancer death among men and women, making up nearly 25% of all cancer deaths, according to the American Cancer Society. More than 200,000 people are diagnosed with lung cancer each year and more people die of lung cancer each year than of colon, breast and prostate cancers combined.

Wider Swath of Eligibility

The new recommendation proposes lowering the eligibility age for a low-dose CT scan of the lungs from age 55 to 50, as well as lowering the number of years a person smoked an average of a pack a day — known as a “pack year” — from 30 years to 20 years to qualify for the test.

“New evidence provides proof that there are real benefits to starting to screen at a younger age and among people with a lighter smoking history,” says USPSTF member Michael J. Barry, MD. “We can not only save more lives, we can also help people stay healthy longer.”

Smoking is the leading cause of lung cancer. Those at high risk are people who have smoked at least 20 pack-years over their lifetime, and still smoke or have quit smoking within the last 15 years. A pack-year is a way of calculating how much a person has smoked. One pack-year is the equivalent of smoking an average of 20 cigarettes, or one pack, per day for a year.

Although the prevalence of smoking has decreased, approximately 37% of U.S. adults are current or former smokers. In 2008, an estimated 7 million U.S. adults aged 55 to 75 years had a 30 pack-year or more smoking history.
U.S. Preventive Services Task Force

“People between 50 and 80 years old who are current or former smokers should talk to their doctor about whether they are at high risk for lung cancer,” the Task Force said in a statement. “If they are, they should discuss the benefits and harms of screening so they can determine whether screening for lung cancer is right for them.”

By expanding who is eligible for screening, the recommendation will be particularly helpful to African Americans and women. While the data show that African Americans and women tend to smoke fewer cigarettes than white men, African Americans have a higher risk of lung cancer than white people. These changes will mean that many more African American and female smokers will be eligible for this potentially life-saving screening.

The Task for has opened the recommendation — an update from its 2013 recommendation with the lower age and “pack years” — to the public for feedback on its website.

“Some really good news from the changes to this recommendation is that it will mean more people are eligible for screening, including notably more African Americans and women,” said USPSTF member John B. Wong, M.D. “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.”

The USPSTF is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Its guidelines impact virtually every primary care patient in the country as their final recommendations become the standard followed by most health-care practices.

Douglas K. Owens

Henry J. Kaiser, Jr. Professor of Medicine
Owens is an expert on cost-effective analysis & clinical decision-making.
doug owens

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