ACS Study Voices Concerns Over Low US Lung Cancer Screening Rates

Lung cancer screening rates in the United States remained low and unchanged in 2015 despite recommendations that high-risk current and former smokers be screened. These were the findings of a study commissioned by the American Cancer Society (ACS) published in JAMA Oncology.

The United States Preventive Services Task Force (USPSTF) has a B-grade recommendation for an annual lung cancer screening among adults 55 to 80 years of age who have a history of smoking 30 packs a year and if they continue to smoke or did, within the past 15 years. The B recommendation means USPSTF expects a moderate to substantial net benefit from the low-dose computed sonography (LDCT) screening service.

The recommendation was made public in December 2013, and the ACS researchers examined data from 2167 qualified respondents from the National Health Interview Survey between 2010 and 2015, to understand the impact of USPSTF’s recommendation. The authors write that the percentage of eligible smokers who reported LDCT screening during 2015 remained low and constant—the number rose less than a percent, from 3.3% in 2010 to 3.9% in 2015 (P = .6). Despite 6.8 million smokers eligible to receive LDCT screening in 2015, barely 262,700 underwent screening. There was no difference in screening rates across sociodemographic groups; the only difference was smokers who had bronchitis had a slightly higher screening rate.

The authors identified lack of awareness about LDCT among smokers, issues with access to care, and physician knowledge-gap on USPSTF recommendations as reasons for the very low screening numbers in 2015.

“Our previous study showed implementing quality screening broadly across the US could prevent about 12,000 lung cancer deaths every year in the short term," said lead author Ahmedin Jemal, DVM, PhD, from the Surveillance and health Services Research division of ACS. "But we cannot prevent those deaths until and unless we start educating eligible smokers as well as clinicians about the benefits and risks of screening, so patients can make an informed decision.”

Reflecting the USPSTF recommendation, the ACS recommends a physician—patient conversation on LDCT scan to check for lung cancer, if the patient meets the following criteria:

• 55 to 74 years of age
• In fairly good health to withstand treatment
• A minimum of 30 pack-year history (equivalent to a pack a day for 30 years or 2 packs a day for 15 years)
• Current smokers or quit within the last 15 years.

A follow-up on this study could be an evaluation of the impact of Medicare’s national coverage determination issued in February 2015, which allowed immediate coverage for LDCT screening among a defined population of Medicare enrollees.

Reference

Jemal A and Fedewa SA. Lung cancer screening with low-dose computed tomography in the United States—2010 to 2015 [published online February 2, 2017]. JAMA Oncol. doi:10.1001/jamaoncol.2016.6416.