USPSTF draft recommendation would expand lung cancer screening

The U.S. Preventive Services Task Force (USPSTF) released a draft recommendation last week recommending annual screening for lung cancer with low-dose CT in adults ages 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit smoking within the past 15 years.

The group's 2014 statement recommended annual screening for lung cancer with low-dose CT in adults ages 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. In both recommendation statements, the Task Force said that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

The draft recommendation statement is online and is open for public comment through Aug. 3. A draft evidence review is also online.

The USPSTF concluded with moderate certainty that annual screening for lung cancer with low-dose CT is of moderate net benefit to those at high risk for lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking. Low-dose CT has high sensitivity and reasonable specificity for the detection of lung cancer, with demonstrated benefit in screening persons at high risk, the draft recommendation stated. Other potential screening modalities, including sputum cytology, chest X-ray, and biomarkers, have not been found to be beneficial, the Task Force said. Based on the available evidence, the USPSTF recommended annual screening.

All patients should receive smoking cessation interventions. To be consistent with the USPSTF recommendation on counseling and interventions to prevent tobacco use and tobacco-caused disease, persons who are referred to a lung cancer screening program through primary care should receive these interventions along with the referral, the statement said. Because many patients get screening outside of the primary care setting, the USPSTF encouraged incorporating interventions into the screening program. The decision to undertake screening should involve a thorough discussion of the potential benefits, limitations, and harms, the statement said.