Lung cancer screening programs meet eligibility criteria

While the vast majority of people who undergo low-dose CT (LDCT) lung cancer screening meet the US Preventive Services Task Force (USPSTF) eligibility criteria, adherence to subsequent screening recommendations is low, according to a population cohort study.

Of the 1,159,092 people who were enrolled in the American College of Radiology’s Lung Cancer Screening Registry (LCSR) and received a baseline LDCT scan between 2015 and 2019, 90.8% met the criteria for the USPSTF, reported Gerard A. Silvestri, MD, of the Medical University of South Carolina at Charleston, and his colleagues at Annals of Internal Medicine.

However, adherence to subsequent screening was “suboptimal,” with only 22.3% of people screened having a follow-up exam 12 months later, as recommended in USPSTF guidelines.

Even extending the window to 24 months or longer than 24 months, only 34.3% and 40.3% of people complied, respectively, with subsequent screening – a rate significantly lower than the 94% adherence rate reported in the National Lung Screening Trial, on which the USPSTF recommendations were based.

“We are encouraged that those screened largely meet the eligibility criteria,” the authors wrote.. Nevertheless, they added, “adherence is key – reduced adherence reduces cost-effectiveness and diminishes mortality benefits. Providers should emphasize that the LDCT is not a ‘one-and-done’ test. .”

Considering that approximately 8 million people in the United States were initially eligible for lung cancer screening when the USPSTF recommendations were first published in 2013, Silvestri and colleagues point out that “adherence to the annual screening is low, which may limit its benefit in terms of mortality.

Silvestri’s group focused on the first million people receiving lung cancer screening in data submitted by the 3,625 facilities reporting to the LCSR.

The authors compiled statistics on the smoking history and sociodemographic factors of these screening recipients and compared them to those of 1,257 respondents to the 2015 National Health Survey (NHIS) who met the screening criteria for the USPSTF of 2013 and which have been calculated to be an accurate representation. of population eligible for screening in the United States

Compared to individuals in the NHIS, recipients of screening in the LCSR were older (34.7% vs. 44.8% were between 65 and 74 years old; prevalence rate [PR] 1.29, 95% CI 1.20-1.39), more likely to be female (41.8% vs. 48.1%; PR 1.15, 95% CI 1.08-1, 23) and more likely to be current smokers (52.3% versus 61.4%; RA 1.17, 95% CI 1.11-1.23).

This meant that the recipients of the screening were less likely to be former smokers. “People who previously smoked may be less likely to have their smoking status recorded in the electronic health record and may not be easily identified as eligible for screening,” they suggested. “Screening may not be a priority for patients or their practitioners during an office visit if they quit smoking years ago.”

The authors also pointed out that while the vast majority of people screened were eligible for the USPSTF according to the 2013 criteria, that still left 9.2% (n=106,501) who were not.

Updated USPSTF recommendations in 2021 (lowering the age criterion from 55 to 50 and the smoking criterion from 30 pack-years to 20) increased the number of individuals eligible for screening to approximately 15 million . This means, according to the authors’ calculations, that 38.0% (n=40,426) of those who underwent baseline screening while not eligible under the 2013 criteria would have been eligible under the current recommendations. .

In an editorial accompanying the study, Karina W. Davidson, PhD, of the Feinstein Institutes for Medical Research at Northwell Health in Manhasset, New York, pointed out that there are still about 6% of people who were inappropriately screened, and she suggested that as screening increases across the country, “many patients could be exposed to harm without potential benefit.”

Davidson suggested that clinicians work with their health systems to ensure there is adequate adherence to annual follow-up screening.

Whether centralized or decentralized approaches are better is still under discussion, she wrote. “Further work is needed to determine whether dedicated nurse navigators, central databases, or other tools are needed to improve the 22% annual follow-up screening rate reported in this sobering real-world registry. “

Finally, Davidson noted that the updated 2021 recommendations roughly double eligibility among those who identify as Native American, Alaska Native, Black or Latino. “Obtaining a smoking history and referring and following up this important, large, and generally medically underserved population segment could significantly reduce lung cancer deaths,” she wrote.

  • Mike Bassett is a writer who focuses on oncology and hematology. He is based in Massachusetts.


Silvestri reported relationships with Nucleix, Delfi, and the American Cancer Society.

Several co-authors reported industry connections.

Davidson did not disclose anything.

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