Absolute lung cancer risk increases among individuals with &gt;15 quit‐years: Analyses to inform the update of the American Cancer Society lung cancer screening guidelines

Landy, Rebecca; Cheung, Li C.; Young, Corey D.; Chaturvedi, Anil K.; Katki, Hormuzd A.

doi:10.1002/cncr.34758

Cited by 7 publications

(15 citation statements)

References 35 publications

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“…This comparative modeling study was based on four lung cancer natural history models, including the two models used in our current analysis. Our findings are also consistent with observational studies showing that the YSQ criterion excludes individuals at high risk of lung cancer from LDCT screening 10–15 …”

Section: Discussionsupporting

confidence: 91%

“…Our findings are also consistent with observational studies showing that the YSQ criterion excludes individuals at high risk of lung cancer from LDCT screening. [10][11][12][13][14][15] The apparent net benefits of including persons who formerly smoked with longer YSQ in LDCT screening can be explained by changes in the age at which screening occurs at the individual and population levels. First, although smoking cessation reduces the risk of lung cancer relative to that of a person who continues to smoke, the lung cancer risk in people who formerly smoked continues to increase in absolute terms as they age.…”

Section: Discussionmentioning

confidence: 99%

“…The authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10,15,20,25,30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated.…”

Section: Methodsmentioning

confidence: 99%

“…

Background:In 2021, the US Preventive Services Task Force expanded its lung screening recommendation to include persons aged 50-80 years who had ever smoked and had at least 20 pack-years of exposure and less than 15 years since quitting (YSQ). However, studies have suggested that screening persons who formerly smoked with longer YSQ could be beneficial.

Methods:The authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10,15,20,25,30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated.

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mentioning

confidence: 99%

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Assessing the impact of increasing lung screening eligibility by relaxing the maximum years‐since‐quit threshold: A simulation modeling study

Meza,

Cao,

de Nijs

et al. 2023

Cancer

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BackgroundIn 2021, the US Preventive Services Task Force expanded its lung screening recommendation to include persons aged 50–80 years who had ever smoked and had at least 20 pack‐years of exposure and less than 15 years since quitting (YSQ). However, studies have suggested that screening persons who formerly smoked with longer YSQ could be beneficial.MethodsThe authors used two validated lung cancer models to assess the benefits and harms of screening using various YSQ thresholds (10, 15, 20, 25, 30, and no YSQ) and the age at which screening was stopped. The impact of enforcing the YSQ criterion only at entry, but not at exit, also was evaluated. Outcomes included the number of screens, the percentage ever screened, screening benefits (lung cancer deaths averted, life‐years gained), and harms (false‐positive tests, overdiagnosed cases, radiation‐induced lung cancer deaths). Sensitivity analyses were conducted to evaluate the effect of restricting screening to those who had at least 5 years of life expectancy.ResultsAs the YSQ criterion was relaxed, the number of screens and the benefits and harms of screening increased. Raising the age at which to stop screening age resulted in additional benefits but with more overdiagnosis, as expected, because screening among those older than 80 years increased. Limiting screening to those who had at least 5 years of life expectancy would maintain most of the benefits while considerably reducing the harms.ConclusionsExpanding screening to persons who formerly smoked and have greater than 15 YSQ would result in considerable increases in deaths averted and life‐years gained. Although additional harms would occur, these could be moderated by ensuring that screening is restricted to only those with reasonable life expectancy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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mentioning

confidence: 99%

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Assessing the impact of increasing lung screening eligibility by relaxing the maximum years‐since‐quit threshold: A simulation modeling study

Meza,

Cao,

de Nijs

et al. 2023

Cancer

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“…(95% CI 7.7-9.7%, P < 0.001). 48 - 65 YSQ criterion could result in an additional 8,275 lung cancer deaths averted, and 115,107 LYG over five years (ie, each person whose life is saved by screening gains an average of 14 years of life). 48…”

Section: Modeling Studiesmentioning

confidence: 99%

Screening for lung cancer: 2023 guideline update from the American Cancer Society

Wolf,

Oeffinger,

Shih

et al. 2023

CA A Cancer J Clinicians

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Lung cancer is the leading cause of mortality and person‐years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network‐validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit‐to‐radiation‐risk ratios from LCS and follow‐up examinations. The GDG also examined disease burden data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50–80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low‐dose computed tomography for asymptomatic individuals aged 50–80 years who currently smoke or formerly smoked and have a ≥20 pack‐year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision‐making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

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Lung Cancer Screening in the US, 2022

Bandi,

Star,

Ashad-Bishop

et al. 2024

JAMA Intern Med

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ImportanceThe US Preventive Services Task Force (USPSTF) recommends annual lung cancer screening (LCS) with low-dose computed tomography in high-risk individuals (age 50-80 years, ≥20 pack-years currently smoking or formerly smoked, and quit &lt;15 years ago) for early detection of LC. However, representative state-level LCS data are unavailable nationwide.ObjectiveTo estimate the contemporary prevalence of up-to-date (UTD) LCS in the US nationwide and across the 50 states and the District of Columbia.Design, Setting, and ParticipantsThis cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) population-based, nationwide, state-representative survey for respondents aged 50 to 79 years who were eligible for LCS according to the 2021 USPSTF eligibility criteria. Data analysis was performed from October 1, 2023, to March 20, 2024.Main Outcomes and MeasuresThe main outcome was self-reported UTD-LCS (defined as past-year) prevalence according to the 2021 USPSTF eligibility criteria in respondents aged 50 to 79 years. Adjusted prevalence ratios (APRs) and 95% CIs compared differences.ResultsAmong 25 958 sample respondents eligible for LCS (median [IQR] age, 62 [11] years), 61.5% reported currently smoking, 54.4% were male, 64.4% were aged 60 years or older, and 53.0% had a high school education or less. The UTD-LCS prevalence was 18.1% overall, but varied across states (range, 9.7%-31.0%), with relatively lower levels in southern states characterized by high LC mortality burden. The UTD-LCS prevalence increased with age (50-54 years: 6.7%; 70-79 years: 27.1%) and number of comorbidities (≥3: 24.6%; none: 8.7%). A total of 3.7% of those without insurance and 5.1% of those without a usual source of care were UTD with LCS, but state-level Medicaid expansions (APR, 2.68; 95% CI, 1.30-5.53) and higher screening capacity levels (high vs low: APR, 1.93; 95% CI, 1.36-2.75) were associated with higher UTD-LCS prevalence.Conclusions and RelevanceThis study of data from the 2022 BRFSS found that the overall prevalence of UTD-LCS was low. Disparities were largest according to health care access and geographically across US states, with low prevalence in southern states with high LC burden. The findings suggest that state-based initiatives to expand access to health care and screening facilities may be associated with improved LCS rates and reduced disparities.

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Absolute lung cancer risk increases among individuals with >15 quit‐years: Analyses to inform the update of the American Cancer Society lung cancer screening guidelines

Cited by 7 publications

References 35 publications

Assessing the impact of increasing lung screening eligibility by relaxing the maximum years‐since‐quit threshold: A simulation modeling study

Assessing the impact of increasing lung screening eligibility by relaxing the maximum years‐since‐quit threshold: A simulation modeling study

Screening for lung cancer: 2023 guideline update from the American Cancer Society

Lung Cancer Screening in the US, 2022

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