Broadened Eligibility for #Lung #Cancer Screening Challenges and Uncertainty for Implementation and Equity

In 2013, the US Preventive Services Task Force (USPSTF) recommended annual lung cancer screening with low-dose computed tomography (CT) in US adults aged 55 to 80 years who currently smoke or formerly smoked with a 30 pack-year history, and for those who formerly smoked, quitting within the past 15 years (grade “B” recommendation).1 In this issue of JAMA, the USPSTF updates this recommendation, proposing 2 significant changes, both related to the population recommended to undergo screening. The first change reduces the age at which to initiate annual screening from 55 to 50 years. The second change reduces the smoking intensity from 30 to 20 pack-year history. Thus, the USPSTF now “recommends annual screening for lung cancer with LDCT [low-dose CT] in 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. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation)”2

It is estimated that these 2 changes will result in 14.5 million US adults being eligible for lung cancer screening under the 2021 recommendations, an increase of 81% (6.4 million adults) from the 2013 recommendations.3 Given the limited uptake of lung cancer screening (range 6%-18%),4,5 and concerns regarding sex, race, and ethnicity-based disparities in eligibility that occurred with the 2013 recommended criteria, it remains to be seen if the revised 2021 recommended criteria can be implemented and will reduce inequities in accessing screening..