Evaluation of Population-Level Changes Associated With the 2021 US Preventive Services Task Force Lung Cancer Screening Recommendations in Community-Based Health Care Systems

Abstract

IMPORTANCEThe US Preventive Services Task Force (USPSTF) released updated lung cancer screening recommendations in 2021, lowering the screening age from 55 to 50 years and smoking history from 30 to 20 pack-years. These changes are expected to expand screening access to women and racial and ethnic minority groups. OBJECTIVETo estimate the population-level changes associated with the 2021 USPSTF expansion of lung cancer screening eligibility by sex, race and ethnicity, sociodemographic factors, and comorbidities in 5 community-based health care systems. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data of patients who received care from any of 5 community-based health care systems (which are members of the Populationbased Research to Optimize the Screening Process Lung Consortium, a collaboration that conductsresearch to better understand how to improve the cancer screening processes in community health care settings) from January 1, 2010, through September 30, 2019. Individuals who had complete smoking history and were engaged with the health care system for 12 or more continuous months were included. Those who had never smoked or who had unknown smoking history were excluded.EXPOSURES Electronic health record-derived age, sex, race and ethnicity, socioeconomic status (SES), comorbidities, and smoking history. MAIN OUTCOMES AND MEASURESDifferences in the proportion of the newly eligible population by age, sex, race and ethnicity, Charlson Comorbidity Index, chronic obstructive pulmonary disease diagnosis, and SES as well as lung cancer diagnoses under the 2013 recommendations vs the expected cases under the 2021 recommendations were evaluated using χ 2 tests. RESULTS As of September 2019, there were 341 163 individuals aged 50 to 80 years who currently or previously smoked. Among these, 34 528 had electronic health record data that captured packyear and quit-date information and were eligible for lung cancer screening according to the 2013 USPSTF recommendations. The 2021 USPSTF recommendations expanded screening eligibility to 18 533 individuals, representing a 53.7% increase. Compared with the 2013 cohort, the newly eligible 2021 population included 5833 individuals (31.5%) aged 50 to 54 years, a larger proportion of women (52.0% [n = 9631]), and more racial or ethnic minority groups. The relative increases in the proportion of newly eligible individuals were 60.6% for Asian, Native Hawaiian, or Pacific Islander;67.4% for Hispanic; 69.7% for non-Hispanic Black; and 49.0% for non-Hispanic White groups. The relative increase for women was 13.8% higher than for men (61.2% vs 47.4%), and those with a lower comorbidity burden and lower SES had higher relative increases (eg, 68.7% for a Charlson (continued) Key Points Question Is the updated US Preventive Open Access. This is an open access article distributed under the terms of the CC-BY License.

Cancer statistics for African American/Black People 2022

“…In 2021, the US Preventive Services Task Force updated their lung cancer screening guidelines by lowering both the age of initiation (from 55 to 50 years) and the packyear smoking history (from 30 to 20 pack-years), consistent with the eligibility criteria for the Multicentric Italian Lung Detection Trial, which found a 39% reduction in lung cancer mortality. 99,100 Although part of the impetus in the change was to attenuate racial and socioeconomic disparities in screening by capturing a larger proportion of Black people at elevated risk, 101 one modeling study found that disparities may widen without the prioritization of individuals with the highest benefit because of unequal dissemination of screening. 102 Survival has increased for patients with lung cancer over the past decade because of advancements in diagnostics, surgical procedures, and therapeutics.…”

Missed Opportunities? An Observational Analysis of Lung Cancer Screening Utilization Amongst Patients With Lung Cancer

“…This gap is expected to close with the new approved USPSTF 2021 LC screening guidelines, 15 which could potentially capture an additional 18 533 eligible individuals. 11 Such impact was seen in our subanalysis, which found significantly increased eligibility rates when implementing USPSTF21 compared to the USPSTF13. However, as it has been described in the literature, eligibility is not equally proportionate to individuals screened.…”

“…This is thought to be promising for high-risk patients and its recommendation was also adapted by organizations including the American Cancer Society. 11 , 12…”

“…This is thought to be promising for high-risk patients and its recommendation was also adapted by organizations including the American Cancer Society. 11,12 Despite clear data and organizations supporting LC screening, studies have shown that the screening rates remain low nationally and LC is still often diagnosed at advanced stages, avoiding their candidacy for surgical resection and curative intent. One study conducted with data from 2015 reported that only 2% of screening eligible subjects was screened.…”

An Opportunity to Reduce Disparities in Lung Cancer Screening

“…Accordingly, wider screening was associated with an estimated 30% increase in lung cancer diagnosis. 1…”