Panel expands eligibility for lung cancer screening
Guidelines could enable 14.5M to receive testing
The U.S. Preventive Services Task Force on Tuesday expanded recommendations for lung cancer screening, which more than doubles the number of U.S. adults eligible for screening, experts say.
The task force made two significant changes to its lung cancer screening: Annual screenings will begin at age 50, instead of 55, and smoking intensity has been reduced from a 30 to a 20 pack-year history. This means patients will eligible if they, for example, smoked one pack a day for 20 years or two packs a day for 10 years.
The inclusive criteria are expected to increase eligibility from 6.4 million adults to 14.5 million, according to an editorial by University of North Carolina School of Medicine professors published in JAMA on Tuesday.
“There’s a huge need to diagnosing patients early,” said Dr. David Carbone, an oncologist and lung cancer specialist at The Ohio State University Comprehensive Cancer Center, who is unaffiliated with the editorial. “When you don’t do screening exams, most lung cancer patients are diagnosed when they’re incurable.”
While health experts agree the updated recommendations is a good first step to becoming more inclusive, they also say it doesn’t address the urgent issue of low uptake. Many Americans who are eligible for screening, even by the 2013 standards, still don’t get screened for lung cancer, said Carbone. This is partly due to racial inequities, financial barriers and lack of awareness and education.
People of color who are diagnosed with lung cancer face worse outcomes compared to white Americans partly because they are less likely to be diagnosed early.
Compared to white Americans, Black Americans with lung cancer are 16% less likely to be diagnosed early; Latinos are 13% less likely; and Asian Americans or Pacific Islanders and Native Americans are 14% less likely, according to the American Lung Association.
Simply expanding the eligibility pool won’t address racial disparities, argues the UNC School of Medicine editorial.
“Implementation will require broader efforts by payers, health systems and professional societies, and in the future, a more tailored individual risk prediction approach may be preferable,” said Louise M. Henderson, editorial co-author and professor of radiology at UNC School of Medicine.
Financial barriers could also exacerbate racial disparities. Medicaid is not required to cover the task force’s recommended screenings, which could lead to greater inequities if recommendations expand to include more people.
People who receive Medicaid are twice as likely to be smokers than those with private insurance, 26.3% compared with 11.1%, Henderson said, and they are also disproportionately affected by lung cancer.
Finally, experts say the screening recommendations won’t do any good for patients at risk for lung cancer if they aren’t aware of them. Most patients eligible for screening are recommended by another cancer or pulmonary specialist, or their primary care physician.
As most people don’t regularly visit specialists, eligible patients would most benefit from primary care physicians ordering lung cancer screenings, said Dr. Bernard Park, a thoracic cancer surgeon at Memorial Sloan Kettering Cancer Center who heads the lung cancer screening program.
“To be able to order a lung cancer screening test, you have a quick fiveminute discussion with the patient about the risk and benefits, they have to be asymptomatic and then they can go off for their scan,” he said.
However, the American Academy of Family Physicians has yet to release updated guidelines for lung cancer screening since recommending against the practice in 2013.