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USPSTF wants to double lung cancer screenings

More Black people and women would be screened under the new criteria.

The United States Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine, released a final recommendation statement on screening for lung cancer on March 9. It says people with a long history of smoking should begin getting annual low-dose CT scans at age 50, five years earlier than the group recommended in 2013. The group also broadened the definition of people it considers at high risk for the disease.

The taskforce’s new recommendation has some differences compared to the American Cancer Society’s guidelineRobert Smith, PhD, senior vice president, cancer screening, shared his perspective on the USPSTF’s recommendation in the statement below. The statement is also posted to and can be used to respond to media as appropriate.   

Statement attributable to Robert Smith, PhD, senior vice president, cancer screening: 

The USPSTF 2021 recommendation for annual screening for the early detection of lung cancer for those who meet the following criteria: Adults aged 50 to 80 years who have smoked a pack a day for at least 20 years, and currently smoke or have quit within the past 15 years.

The two major changes from the 2013 recommendation are lowering the age to start screening from 55 to 50, and lowering the pack-year smoking history from 30 pack-years to 20 pack-years. 

Significance of Changes 

Despite smoking less, there is evidence that Black adults who smoke are at higher risk for lung cancer than white adults (i.e., at a lower pack-years smoking history). Lowering the pack-year history will increase the number of adults who are eligible for screening among those who currently smoke or formerly smoked, which is important for those who are at higher risk with at lower pack year histories. Similarly, Latinx/Hispanics who smoke accumulate less pack-years history than whites who smoke, and women accumulate less pack-years history than men, so more Latinx/Hispanic adults who smoke and women would be eligible for screening under the new guidelines. 

Insurance Coverage 

Under the Affordable Care Act, all non-grandfathered private insurance plans and Medicaid expansion plans will have to provide coverage according to the new guidelines. For private insurance, the plan must begin covering the USPSTF recommended preventive service beginning in the plan year that begins on or after one year from the date the recommendation is issued. Medicare will have to choose to update its National Coverage Determination. 

Current ACS Guidelines 

Our lung cancer screening guideline was last updated in 2013, and an update will be initiated in 2021. The current recommendation is for annual screening for the early detection of lung cancer using a low-dose spiral computed tomography (LDCT) for those who meet the following criteria: 

  • Aged 55 to 74 in relatively good health (note the Centers for Medicare and Medicaid Services covers screening to age 77, and the USPSTF recommends screening for adults up to age 80. The ACS guideline should not discourage adults who are healthy and eligible for screening to continue past age 74)
  • Currently smoke or quit in the past 15 years
  • 30+ pack-year smoking history

ACS also recommends these individuals undergo informed/shared decision making with a clinician and discuss the potential benefits, limitations, and harms of screening prior to referral in addition to being counseled on smoking cessation.

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