New USPSTF Lung Cancer Screening Recommendations Would Double Scans Among Blacks, Women

July 8, 2020

Lowering the age and smoking history standards would result in substantially more Blacks and women being eligible for screening.

The United States Preventive Services Task Force (USPSTF) announced proposed changes to its lung cancer screening recommendations today that the task forces estimates would more than double the number of Black Americans eligible for screening and also increase the eligibility of women.

USPSTF is proposing to recommend annual screening for adults, ages 50 to 80, who have a 20 pack-year smoking history and either currently smoke or quit smoking within the past 15 years.

The current recommendation, which dates from 2014, is for annual screening to start five years later, at age 55, and for a history of heavier smoking — 30 pack-years instead of 20.

A pack-year is a common way of measuring a person's exposure to cigarettes and is calculated by counting the number of years that a person has smoked, on average, 20 (the number of cigarettes in a pack) cigarettes a day.

Starting screening at age 50 and including people with lighter smoking histories would increase the number of Americans eligible for lung cancer screening by 86% overall, the task force says in the discussion section of its guidelines.

Among non-Hispanic Blacks, the relative increase would be 105% compared with 77% among non-Hispanic whites, the task force says. There would also a gender difference with the wider eligibility: an 81% relative increase among men compared with a 96% increase among women.

The task force mentions that African American have a higher risk of lung cancer than whites and that the difference in risk is more apparent at lower levels of smoking. It also cites a study that found that 17% of African American smokers were eligible for screening using the 2014 USPSTF recommendations compared with 31% of white smokers.

The proposed updated recommendation and the 2014 recommendation both set 80 as the the upper-age limit for screening. They update also doesn't differ from the 2014 recommendations in saying that lung cancer screening should stop once someone hasn't smoked for 15 years or develops a heart problem that substantially shortens their life expectancy.

Possible harms from lung cancer screening include false positives and related workups, and radiation exposure from the the low-dose CT scans used in screening, according to the task force. Lung cancer screening also results in incidental findings that may lead to more imaging and tests — imaging and tests that may, depending on the finding, be unnecessary and possibly cause harm.

The USPSTF gave its lung cancer screening recommendation a "B" grade, which means it sees a moderate net benefit as being highly certain or has moderate certainty of a moderate-to-substantial benefit.

The task force is accepting public comments on its proposed recommendation till August 3.