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USPSTF Solidifies its Recommendations for Lung Cancer Screenings

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The U.S. Preventive Services Task Force (USPSTF) has officially announced that annual low-dose CT screening for lung cancer is recommended for high-risk individuals.

The final grade B recommendation for adults ages 55 through 79 with a 30 pack-year history of smoking or who have quit in the past 15 years met the draft recommendations released in July.

The only changes based on comments received during the public comment period were that smoking cessation was more significantly highlighted as a part of screening programs and the description of the suitable patient population was moved to the top of the document.

"It's very clear that the best way to prevent lung cancer deaths is to quit smoking. So we have that emphasized much more significantly, particularly in the section called clinical considerations, to make sure people don't think this is an excuse to keep smoking,” explained task force co-vice chair Michael L. LeFevre, MD, MSPH, of the University of Missouri in Columbia.

The draft had included in the clinical considerations section a recommendation in opposition to screening individuals with significant comorbidity, particularly those nearing the age cutoff of 80.

The final recommendation, published online in Annals of Internal Medicine, stated that into the initial description of the screening recommendation and repeated it again in the main body of the document.

"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," it said.

A following editorial called the recommendations important, but warned that the USPTF left out many of the sensible aspects of applying a lung cancer screening program, as for instance what to do with people who want to be screened, but do not meet the given criteria.lung caner

“These people have reasons for their concerns; turning them away because they do not meet the criteria does not provide them the reassurance they seek," argued Frank C. Detterbeck, MD, of Yale University, and Michael Unger, MD, of the Fox Chase Cancer Center in Philadelphia.

Other problematic concerns are how to involve primary care physicians who may do the immensity of referring and determining who, when, and how to treat screen-detected cancer, they mentioned.

"This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning of screening for lung cancer," Detterbeck and Unger wrote.

LeFevre predicted that these screening programs have quickly sprouted across the nation, and the USPSTF recommendation should be able to give centers a bigger boost by leading to reimbursement.

“The Affordable Care Act mandates that private insurers cover without co-pay or deductible services the task force grants an "A" or a "B" recommendation. However, Medicare won't be required to cover such services,” Peter B. Bach, MD, MAPP, of Memorial Sloan-Kettering Cancer Center in New York City, noted in a second editorial.

Bach also criticized the lack of distinction of truly high-risk individuals within the screened population.

Overall, screening had "only moderate certainty of a moderate net benefit," yet the number required to screen to prevent a lung cancer death differed across the screened population, from 161 in the highest risk to 5,276 in the lowest risk participants in the National Lung Screening Trial (NLST), which constituted the main basis for the recommendations.

"Perhaps the high-risk group should have qualified for an 'A'; perhaps the latter should get only a 'C,' a service that should be only selectively offered," Bach suggested.

He also criticized the group's extrapolation beyond the trial data.

"On the basis of models, the Task Force chose to lengthen the duration of screening to a maximum of 26 years and increase the upper age of eligibility for screening to 80 years, even though NLST participants were screened for only 3 years and were ineligible to enroll if they were older than 74 years (only 8.8% of participants were ages 70 years or older at enrollment)," he pointed out.

"This may be appropriate, but here, too, the grading of this extrapolation should match the low level of evidence supporting it," Bach said.

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