The U.S. Preventive Services Task Force (USPSTF), an independent panel of non-Federal experts that conducts scientific evidence reviews of preventive health care services for the U.S. government, is posting its draft recommendations for lung cancer screening using low-dose computed tomography (LDCT). The recommendations, which are not final but instead posted for comment by experts and the general public, give annual screening in those at high risk for lung cancer (based on age and smoking history) a “Grade B” recommendation, indicating high certainty that the net benefit is moderate or moderate certainty that the net benefit is moderate to substantial.
We asked Otis W. Brawley, M.D., chief medical officer, for his thoughts on these new draft recommendations.
“This update to the USPSTF’s 2004 lung cancer screening recommendation has been long anticipated, and adds to a growing consensus that using low dose spiral CT to screen high risk individuals, based on age and smoking history, should be considered.
“Within the screening profession, the Task Force reviews are viewed as the most exhaustive and rigorous with very high standards for grading the quality of studies under review. Most importantly the Task Force takes into account the quality of each study considered. That’s important because some studies are better than others, and some study results are not as reliable as others.
“This draft recommendation recognizes that low-dose spiral CT almost certainly saves lives when done on individuals at high risk for lung cancer, based on age and smoking history. It also recognizes that there are harms associated with spiral CT lung cancer screening. It says screening is reasonable for healthy people who have at least a 30 pack-year history of smoking, who are between 55 and 79, and who have smoked within the past 15 years. It also says that health professionals should be cautious about recommending screening to patients at the upper end of this age range who have other significant health issues.
“The draft recommendation is very consistent with the recommendation from other organizations, including the American Cancer Society. A little more than a year ago the Society and several other professional organizations recommended that people at high risk for lung cancer, based on their age and smoking history (age 55 or over and greater than 30 pack-year smoking history) consider the documented benefits and risks of screening and make an informed decision. These criteria are essentially the same as those that were used as study eligibility criteria for the U.S. National Lung Screening Trial (NLST), which was run by the National Cancer Institute and supported by the American Cancer Society, which helped recruit participants whose contribution gave us critical evidence about using this new tool.
“One notable difference between the USPSTF draft recommendation and the ACS guidelines is the high emphasis the ACS places on informed decision making about the benefits and harms associated with screening for lung cancer; in particular, the high likelihood of false positive test results on the initial screening test that will require additional follow-up. In contrast, the USPSTF endorses shared decision making only for eligible individuals who have significant health issues. It’s important to remember that this is a draft recommendation, and that and other aspects of the recommendation could change in the final version.
“The USPSTF gives lung screening using low dose spiral CT a “B” recommendation. Under the Affordable Care Act (ACA), new private health insurance plans and Medicaid plans for newly eligible enrollees must cover screenings that receive an “A” or “B” rating with no deductibles or co-pays . Most health insurance companies have delayed offering coverage for lung cancer screening pending the outcome of the USPSTF review.
“The new recommendation is likely to result in increased demand and promotion for lung cancer screening in the U.S. It is critically important that programs and policies are put into place to insure that best practices are put into place to insure that screening for lung cancer achieves the greatest potential benefit with the fewest harms.”