Lung cancer screening recommendation finalized


The recommendation includes annual low-dose Computed Tomography (CT) lung cancer screening for high-risk individuals.

The final grade B recommendation for adults ages 55 through 79 with a 30 pack-year history of smoking or who have quit in the past 15 years came from the U.S. Preventive Services Task Force (USPSTF).

The only changes based on comments received during the public comment period were that smoking cessation was more prominently emphasized as a component of screening programs and the description of the appropriate patient population was moved to the top of the document.


"It's very clear that the best way to prevent lung cancer deaths is to quit smoking," he told MedPage Today. "So we have that emphasized much more significantly, particularly in the section called clinical considerations, to make sure people don't think this is an excuse to keep smoking."

The draft had included in the clinical considerations section a recommendation against screening individuals with significant comorbidity, especially those nearing the age cutoff of 80.

The final recommendation, published online Monday in Annals of Internal Medicine, moved that into the initial description of the screening recommendation and repeated it again in the main body of the document.


An accompanying editorial called the recommendations important, but cautioned that they left out many of the practical aspects of implementing a lung cancer screening program, such as what to do with people who want to be screened but don't meet the criteria.

"These people have reasons for their concerns; turning them away because they do not meet the criteria does not provide them the reassurance they seek," wrote Frank C. Detterbeck, MD, of Yale University, and Michael Unger, MD, of the Fox Chase Cancer Center in Philadelphia.

Other issues are how to involve primary care physicians who may do the bulk of referring and determining who, when, and how to treat screen-detected cancer, they pointed out.

"This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning [of screening for lung cancer]," Detterbeck and Unger wrote, riffing on Winston Churchill.

These screening programs have rapidly rolled out across the country, and the USPSTF recommendation should give centers a further boost by leading to reimbursement, LeFevre predicted.

The Affordable Care Act mandates that private insurers cover without copay or deductible services the task force grants an "A" or a "B" recommendation.

However, Medicare won't be required to cover such services, Peter B. Bach, MD, MAPP, of Memorial Sloan-Kettering Cancer Center in New York City, noted in a second editorial.

He criticized the lack of distinction of truly high-risk individuals within the screened population.

Overall, screening had "only moderate certainty of a moderate net benefit," but the number needed to screen to prevent a lung cancer death varied across the screened population, from 161 in the highest risk to 5,276 in the lowest risk participants in the National Lung Screening Trial (NLST), which formed the main basis for the recommendations.


He also criticized the group's extrapolation beyond the trial data.




Source: MedPage Today:

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