Lung Cancer Screening Back In The News!

So this is really just an announcement. As many of you already know, the USPSTF (US Preventive Services Task Force) recommended lung cancer screening years ago after a huge study was published in 2011 in the New England Journal of Medicine demonstrating a 20% reduction in mortality in the heavy smokers when screened with low dose CT. This was compared to xray at the time. I bet the radiography cohort would have performed better with some of the new AI and computer aided detection stuff being shopped around now, but that is a whole separate discussion and I know studies are already looking at that. Anyway, it took a little while, but eventually CMS (Centers for Medicare & Medicaid Services) approved lung cancer screening with a more narrow window of a population than I had liked at the time, but, you take what you can get from government nowadays, so at least it was approved.

Many of you have already been doing lung cancer screening for several years now and I am sure you are aware of the current eligibility criteria that CMS is requiring:
Age 55 – 77 years
Asymptomatic (no signs or symptoms of lung cancer)
Tobacco smoking history of at least 30 pack-years
Current smoker or one who has quit smoking within the last 15 years
Order from doctor
A shared decision making visit
Patient would accept treatment if a cancer was found
Co-morbidities wouldn’t prevent cancer treatment

I may have missed an item, but those are the main criteria. As I said above the guidelines were a little narrow (USPSTF suggested 55-80, but CMS didn’t go for it) and several medical societies criticized CMS for this. Anyway, more studies, 10 years later and lots of expert opinions and the USPSTF has just upped the ante. They now recommend annual screening for lung cancer with low-dose CT in adults aged 50 to 80 years who have a 20 pack-year smoking history.

Yeah baby, this is more like it!

Since a 20 pack year history of smoking is pretty heavy and the 2 main risk factors for lung cancer are smoking and age, I’m super happy they finally adjusted their criteria. So hopefully this puts a little more pressure on CMS, but now we have to wait for medicare to take up the new recommendations. Let’s see if they approve the expanded parameters. If so, this will certainly expand access to a much larger number of patients and we are off to the races. More screenings of these high risk patients will allow us to pick up more early stage and very treatable lung cancers before they become hard to treat or untreatable. So that’s it everyone. Just a quick announcement of what’s coming down the pike. Talk to you soon.

Here are the links to the original New England Journal study from 2011, and the NEW USPSTF statement, March 2021.

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