The U.S. Preventive Services Task Force (USPSTF) has formally recommended 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 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 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 computed tomography (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.
Kathy Leiser of Nashville, a lung cancer patient advocate, welcomed the change. She has benefited twice from undergoing screenings. In 2011, her lung cancer was discovered when she participated in a Vanderbilt screening trial for current and former smokers to determine biomarkers that could be helpful for early diagnosis. The 2.8-centimeter tumor in her right upper lobe was surgically removed. Since then, she has undergone yearly CT scans.
“That important follow-up paid off last year,” Leiser said. “A spot my pulmonologist noticed in 2018 and watched yearly changed in size in 2020. That prompted a biopsy and found a very small, 8-millimeter, very early-stage adenocarcinoma. I had radiation last September with minimal impact on my lung function. CT scans are indispensable tools in early detection.”
Kim Sandler, MD, co-director of the Vanderbilt Lung Screening Program, said she hopes younger patients with histories of smoking will now undergo the CT scans, which are painless and noninvasive.
“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 Sandler, professor of Radiology and Radiological Sciences and a co-author of the JAMA Oncology study.
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.