March 9, 2021 – More long-term cigarette smokers are urged to get lung cancer screening under new guidelines released by the U.S. US Preventive Services Task Force .

The new recommendations are that anyone age 50 and older who have smoked for at least 20 years should be screened each year. The previous guidelines were for those over 55 who had 30 years smoking.

"This is great news because it means that nearly twice as many people are eligible to be screened, which we hope will allow clinicians to save more lives and help people remain healthy longer," said John Wong, MD, chief science officer, vice chair for clinical affairs, and chief of the Division of Clinical Decision Making at the Task Force.

The updated final recommendations were published online today in JAMA.

The Task Force recommends annual screening for adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

This updates the guidance issued in 2013, which recommended annual screening for lung cancer for adults aged 55 to 80 years who had a 30 pack-year smoking history and who were either current smokers or had quit within the past 15 years.

The move will nearly double the number of people now eligible for screening, up to 14.5 million individuals ― an increase of 81% (6.4 million adults) from the 2013 recommendations.

The expanded criteria may also help increase screening among Black people and women. Data shows that both groups tend to smoke fewer cigarettes than White men and that Black people are at higher risk for lung cancer than White people.

In addition, research has shown that about one third of Black lung cancer patients were diagnosed before the age of 55, which means they would not have been recommended for screening under the previous guidelines.

Screening Works

The new recommendations will open up screening to many more people, but challenges remain. "The science is clear that lung cancer screening has the potential to save lives," Wong told Medscape. "We recognize that there are existing barriers to screening everyone who is eligible, but clinicians and patients both deserve to know that screening can detect lung cancer early, when treatment has the best chance of being beneficial."

He added that the hope is that these recommendations will encourage doctors to examine the barriers to effective lung cancer screening in their communities.

In anaccompanying editorial, Louise M. Henderson, PhD, M. Patricia Rivera, MD, and Ethan Basch, MD, all from the University of North Carolina at Chapel Hill, address some of the challenges in getting patients to come for screening.

They note that Medicare reimbursement for lung cancer screening requires paperwork to be submitted to a Centers for Medicare & Medicaid Services–approved registry, which can cause problems for clinics serving lower-income communities or that have limited resources.

Medicaid coverage is also uneven: As of September, lung cancer screening was covered by 38 Medicaid programs, but not by nine; for three, data on coverage were not available.In addition, many people in at-risk populations lack adequate access to comprehensive lung cancer screening programs.

"A concerted effort to increase the reach of lung cancer screening is needed," the write. "The 2021 USPSTF recommendation statement represents a leap forward in evidence and offers promise to prevent more cancer deaths and address screening disparities. But the greatest work lies ahead to ensure this promise is actualized."

Advocacy Needed

Jianjun Zhang, MD, PhD, from the University of Texas MD Anderson Cancer Center, said he supports the new guidelines and says they will lower mortality. "The data are pretty strong overall," he said in an interview.

Although the level of screening is very low, he said more lives will be saved because eligibility has been expanded. "More people will be getting screened, so it's a start," he said.

Aside from factors such as insurance and access, another problem involves primary care.

"Time is very limited in primary care," he said. "You have about 15 minutes, and it can be really hard to fit everything into a visit. Screening may get left out or may only get a brief mention."

Advocacy is needed, Zhang pointed out. "Breast cancer has strong voices and advocacy, and people are more aware of mammography," he said. "The information is disseminated out into the community. We need the same for lung cancer."

Zhang emphasized that even with the expanded criteria, many individuals will still be missed. "There are other risk factors besides smoking," he said. "About 10% of lung cancers occur in never-smokers."

Other risk factors include a family history of lung cancer, exposure to certain materials and chemicals, working in the mining industry, and genetics. "We will move on to more personalized screening at some point," he said. "But right now, we can't make it too complicated for patients and doctors. We need to concentrate on increasing screening rates within these current criteria."

The updated guidelines has been given a B recommendation, meaning that the Task Force recommends that doctors provide the service to eligible patients and that there is at least fair evidence that this service improves important health outcomes and that benefits outweigh harms.