Age-based screening for lung cancer may be more cost-effective and improve detection compared to current screening criteria in the United States
1. Current US Preventive Services Task Force (USPSTF) screening criteria for lung cancer excludes many at-risk individuals and has poor adherence – age-based screening is cost-effective and improves detection.
Evidence Rating Level: 2 (Good)
Current USPSTF guidelines for lung cancer screening includes patients aged 50-80 years, have ≥ 20 pack-years, and are currently smoking or or quit < 15 years ago. Low-dose computed tomography (LDCT) has been proven to be effective for early detection; however, participation rates remain below 15% of eligible individuals, and there exist multiple nontobacco risk factors in lung cancer development. The authors sought to determine what proportion of patients meet USPSTF criteria, and if age-based screening would improve detection and be cost-effective. This retrospective cohort study found that of 997 patients (median [IQR] age: 67 [18-99]; 58.0% female) diagnosed with lung cancer, 45 patients underwent LDCT screening. 35.1% met USPSTF screening criteria, and 12.6% of these patients underwent LDCT screening. Expanding criteria to age 40 to 85 years, 10 or more pack-years, and no cessation limit increased detection to 62.1% (619 of 997 patients). Age-based screening (40-85 years) captured 93.9% of cases and prevented 26,124 deaths annually (95% CI, 20,000-32,248 deaths annually) at $101,000 per life saved (95% CI, $82,000-$120,000). This study suggests current USPSTF guidelines have poor adherence and are insufficient at capturing the majority of patients with lung cancer. Age-based screening improves detection and is cost-effective.
Click here to read this study in JAMA Network Open
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