USPSTF: Screen smokers for lung cancer

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Lung Cancer

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Smokers fare worse after stroke

HealthDay News -- The U.S. Preventive Services Task Force (USPSTF) is recommending adults aged 55 through 79 who have a 30 pack-year history of smoking or who have quit in the prior 15 years undergo annual low-dose CT lung cancer screening.

"Sadly, nearly 90% of who people develop lung cancer die from the disease, in part because it often is not found until it is at an advanced stage," task force chair Virginia Moyer, MD, MPH, said in a statement. "By screening those at high risk, we can find lung cancer at earlier stages when it is more likely to be treatable." 

The draft recommendation carries a B grade, which is important because preventive tests with and A or B grade require Medicare, other federal health programs and private insurers to cover the costs within a year after a guideline is adopted.

The task force previously recommended against lung cancer screening (grade D) in 1996 and said there was insufficient evidence to make the recommendation when it was reviewed again in 2004.

The latest USPSTF Recommendation Statement is based on evidence from a systematic review that includes data from the 2010 National Lung Screening Trial (NLST) and three other studies that reported results from low-dose CT screening among current and former smokers.



Results from the NLST, which involved more than 50,000 people, found that screening significantly reduced lung cancer and all-cause mortality (20% and 6.7%, respectively), with a number needed to screen to prevent one lung cancer death of 320 and 219 to save one life overall.

In comparison, it takes 900 to 1,900 mammograms to save one life from breast cancer and about 800 colonoscopies to save one life from colon cancer, the task force noted.

No benefit of screening was seen in the other three small European trials included in the review. However, these studies were "underpowered and of insufficient duration to evaluate screening and effectiveness," according to the researchers.

Low-dose CT screening tools may be able to reduce lung cancer and all-cause mortality, but the benefits of screening should be weighed against the potential harms, the task force concluded.

Although several organizations including the American Cancer Society, the American College of Chest Physicians and the National Comprehensive Cancer Network have recommended lung cancer screening in the past, many primary care clinicians do not currently recommend CT lung cancer screening and few insurance companies cover the expense.

Out-of-pocket expenses range from $50 to $400, but under the Affordable Care Act, insurance companies are required to cover any screening service with a USPSTF grade if an A or B without  a copay or deductable.

The draft Recommendation Statement appears in Annals of Internal Medicine and is available for public comment from July 30 to Aug. 26, 2013.


References

  1. Humphrey LL et al. Ann Intern Med 2013; doi: 10.7326/0003-4819-159-6-201309170-00690.
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