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USPSTF Finalizes Recommendation for Lung Cancer Screening

Guideline Watch |
January 28, 2014

USPSTF Finalizes Recommendation for Lung Cancer Screening

  1. Allan S. Brett, MD

Older people (age range, 55–80) with 30–pack-year smoking histories are eligible.

  1. Allan S. Brett, MD

Sponsoring Organization: U.S. Preventive Services Task Force (USPSTF)

Target Audience: Primary care providers

Background and Objective: Evidence-based recommendation on screening to prevent lung cancer deaths among people with long smoking histories

Key Points

  • The USPSTF recommends annual screening with low-dose computed tomography (LDCT) in older adults (age range, 55–80) with 30–pack-year smoking histories who smoke currently or have quit within the past 15 years.

  • Screening should be discontinued if a person has not smoked for ≥15 years; screening is not warranted for patients with medical conditions that limit life expectancy.

What's Changed

The previous USPSTF guideline (from 2004) stated that the evidence was insufficient to recommend for or against lung cancer screening by any method.

Comment

According to the USPSTF grading system, this is a B recommendation (i.e., moderate certainty that annual LD computed tomography provides substantial net benefit). The first draft of this recommendation was made available for public comment in July 2013 and was covered in detail by NEJM Journal Watch General Medicine (NEJM JW Gen Med Aug 8 2013). This final recommendation essentially is unchanged; it is based largely on the results of the 2011 National Lung Screening Trial (NLST; NEJM JW Gen Med Jul 14 2011) and on computer models that extrapolate beyond the NLST study. For example, people were screened annually for only 3 years in the NLST, whereas this guideline recommends annual screening within the 25-year age span.

Because of the harms of screening (i.e., false-positive results and overdiagnosis), the guideline suggests that screening should be done at centers with “high rates of diagnostic accuracy using LDCT, appropriate follow-up protocols for positive results, and clear criteria for doing invasive procedures.” As one editorialist stated, “The USPSTF recommends a structured screening process, not simply a scan.” This aspect of the recommendation will pose a problem for many primary care providers whose patients request screening, because structured programs are not yet available in most places.

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

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