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Criteria for lung cancer screens may be expanded

Jul. 23, 2020, 9:42 AM

 

by Tom Wilemon

The U.S. Preventive Services Task Force (USPSTF) is recommending two changes that will nearly double the number of people eligible for lung cancer screening by lowering the age from 55 to 50 and reducing the number of smoking history pack years from 30 to 20.

The recommendations, which are currently in the public comment phase and not yet formally adopted, have particular significance for women and African Americans.

The USPSTF cited a 2019 study by Vanderbilt researchers in their decision analysis. The study, published in JAMA Oncology, revealed a striking disparity in eligibility between races. Among smokers diagnosed with lung cancer, 32% of African Americans versus 56% of whites were eligible for screening. The researchers reviewed cancer incidence data on 48,364 smokers from the Southern Community Cohort Study in one of the largest comprehensive evaluations of lung screening guidelines established by the USPSTF.

“The draft recommendations put forth by the USPSTF are a step forward in the right direction to improve lung cancer screening eligibility criteria for those at high-risk, however, more work is needed to address disparities that still likely exist,” said the study’s lead author, Melinda Aldrich, PhD, MPH, associate professor of Medicine, Thoracic Surgery and Biomedical Informatics.

The USPSTF issued the existing guidelines in 2013 after the National Lung Screening Trial demonstrated that CT scans provided early detection of lung cancer and reduced deaths from the disease by 20% compared to participants who received standard chest X-rays. Aldrich and fellow researchers concluded that those guidelines may be too conservative for African Americans, setting the stage for later diagnoses and reduced odds of survival.

“There has been a large body of evidence published since the National Lung Screening Trial showing significant benefit to expanding screening eligibility to younger individuals and those with less tobacco exposure.  The adjustment of these guidelines is an extremely important step that will allow us to screen earlier in order to continue to improve morbidity and mortality from lung cancer,” said Kim Sandler, MD, assistant professor of Radiology and Radiological Sciences, co-director of the Vanderbilt Lung Screening Program and co-author of the study.

The recommendation out for a public comment is Grade B, which suggests insurers and providers should offer the service.

“It is wonderful to propose workable solutions to reduce screening disparity and potentially see those solutions adopted,” said Jeffrey Blume, PhD, professor of Biostatistics, Biomedical Informatics, and Biochemistry and director of Graduate Studies at Vanderbilt’s Data Science Institute. “However, there is still more work to be done. These screening procedures need to be fine-tuned for each target population so that screening equity is the same across different populations. It’s a little counterintuitive, but a necessary step for reducing disparities.”

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. 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 Vanderbilt Lung Screening Program offers CT scans for $145 for people who do not meet screening criteria. The program also provides qualitative calcium scores linked to smoking-related cardiac disease and provides tobacco cessation counseling.

For more information, call 615-322-0580 or email Alexis Paulson, MSN, APRN, clinical coordinator of the Vanderbilt Lung Screening Program at alexis.b.paulson@vumc.org.

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