U.S. Preventative Services Task Force Issues New Recommendation for Lung Cancer Screening

3 min read

The United States Preventive Services Task Force (USPSTF) has issued 2021 guidelines for lung cancer screening. The last change made to these guidelines was in 2013.

What is a screening test?

A screening test is for people at risk for a condition but who have not yet been diagnosed. Screening tests attempt to catch a condition in its early stages. Examples of screening tests include colonoscopy for colon cancer and Pap smear for cervical cancer.

Lung cancer screening

In lung cancer, the common screening test is a computed tomography (CT) scan. A CT scan is similar to an X-ray. However, CT scans create a 3-dimensional image of the body and provide more detail. Because of this, CT scans expose a person to more radiation. There is a lower-radiation version of CT called a low-dose computed tomography (LDCT) scan. This is used in lung cancer screening.

If a person’s lung cancer is detected earlier, their chance of successful treatment is higher. For example, a stage 1 lung cancer found with screening may be cured with surgery or radiation. However, if a person was not screened and their cancer was found later on, the chances the cancer has spread are higher. More advanced cancers are harder to treat.

How have the recommendations changed?

The 2021 recommendations encourage yearly LDCT scans in people between the ages of 50 and 80 years old who have smoked 20 pack-years. This includes people who have quit smoking in the last 15 years. The guidelines are not meant for people who have quit smoking more than 15 years ago.^1,2

One pack-year means smoking 1 pack of cigarettes a day for a year. Someone with a 20 pack-year smoking history has smoked a pack a day for 20 years. It can also mean smoking 2 packs a day for 10 years or any other combination that averages to 20 pack-years.^1,2

This is different from the 2013 guidelines in age and smoking history. The 2013 guidelines included people between the ages of 55 and 80 years old. Also, the older guidelines were for people with a 30 pack-year history instead of 20 pack-years.^1,2

Why are these changes important?

The 2021 guidelines will include younger people and people with less of a smoking history. The number of people eligible for screening will almost double.^1-3

This change is especially important for women and minority groups. Both of these groups tend to smoke less than white men, who make up a large percentage of those previously eligible for screening.^1-3

Although women and Black people may smoke less on average, they are still at risk. Research has suggested that Black people specifically have a higher risk of developing lung cancer than white people. This is true even when they have less of a smoking history.^1-3

What are the risks of these changes?

As with any medical test, there are risks of increased screening. Although experts say the chances are low, it is possible to have false-positive screening tests. This may mean finding something that is not cancerous but looks like a potential cancer. Examples include benign lung nodules and infections, among others.^1,2

Positive screening tests often lead to more scans, biopsies, or even surgery. These can be invasive, risky, and costly. Additionally, potentially having cancer can lead to anxiety and distress. Further tests are helpful if a person does have cancer. However, all of these efforts and stress may be unnecessary if the screening test was a false-positive.^1,2

Radiation exposure can also cause lung cancer. Some experts have wondered if yearly CT scans actually increase risk. However, the amount of radiation in LDCT is thought to be even lower than the background radiation a person is exposed to each year. While there is still a risk that yearly CT scans could lead to cancer, the estimated number of these cases is still less than the potential deaths prevented.^1,2

In all cases, a person and their doctor can discuss the personal risk of lung cancer, as well as the risks and benefits of screening.

What is the U.S. Preventative Services Task Force?

The USPSTF is a group of independent medical experts. They review data and make decisions on preventive medicine and treatment options. They recommend screening tests, counseling topics, and more. They grade their recommendations A, B, C, D, and I (insufficient) based on the data used and how confident they are in the potential benefits. A and B are the strongest grades.^1,2

The 2021 lung cancer screening guidelines have a grade B recommendation.^1,2

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Richard Faust Community Admin
Hi all. I concur with others that this is a step in the right direction to including more at risk individuals and populations in the screening process, but also suffers limitations, such as continuing to only focus on the population of smokers or previous smokers. For example the word Radon appears nowhere in the report. I saw one article that suggested that these limitations had to do with the difficulty in doing multiple modeling and risk assessments for what they deemed too small a percentage of potential patients. I find this excuse lacking, along with the fact that the task force never seems to consider that screening can be done in variations other than every year depending on risk levels in relation to over-diagnosis or additional radiation risk levels. This may partially be due to the fact that one of (if not the major) drawback to the task force is that it covers so many conditions and does not include subject matter specialists (the doctor from the task force most quoted in relation to this report may be an excellent doctor, but he is an internist, not an oncologist, radiologist, or pulmonologist). This research article/analysis of the recommendations I found gives a good overview of the benefits of the expansion of screening, as well as including a statistical look at the counterbalancing risks. It is also particularly good at analyzing the difficulty of actually getting those recommended for screening to get the procedure: <a href='https://www.diagnosticimaging.com/view/uspstf-updates-recommendation-for-ldct-lung-cancer-screening?fbclid=IwAR1SzDwXYweaNQNJGDVo9jKE8n-cBFbl3-92ZXFQdf_ohOaL-7QYxJWY1wg' target='_blank' rel='noopener noreferrer ugc'>https://www.diagnosticimaging.com/view/uspstf-updates-recommendation-for-ldct-lung-cancer-screening?fbclid=IwAR1SzDwXYweaNQNJGDVo9jKE8n-cBFbl3-92ZXFQdf_ohOaL-7QYxJWY1wg</a>. Best, Richard (LungCancer.net Team)
Yolanda Brunson-Sarrabo Moderator
I'm all for this new screening. I would have to say it's a little late to the party; however, appreciate it all the same.
Kits Member
I am curious why these recommendations do not address the risks for ex smokers with partners that have continued to smoke 25+ years after they personally quit. Second and third hand smoke also carries a risk.
1. Diane Spry Moderator
 That is a very good question, Kits. I hope that they continue to update the requirements for lung cancer screening. 
2. Yolanda Brunson-Sarrabo Moderator
 <inline-mention username="Kits" user-id="4211012"/> Good point, but I suppose it's an ongoing process. I hope they include that point down the line.
vikkr Member
It needs to include those who lived in a home or work where people smoked and you were exposed to second hand smoke, as well as those who might have been exposed to radon and other similar exposures that put people at risk. it should not JUST say screenings for smokers or former smokers. By doing so they only add to the stigma that ONLY people who smoke or smoked get lung cancer. USPSTF needs to do a better job. 
1. vikkr Member
 <inline-mention username="Alisa" user-id="2346003"/> You're right, family history should also be included. I sometimes forget about that part since I am adopted but yes it needs to be expanded widened period. 
2. Yolanda Brunson-Sarrabo Moderator
 <inline-mention username="vikkr" user-id="2367442"/> There are so many opportunities here to make this make sense to benefit those smokers and non-smokers in the mix. I think what we can do is keep our ears to the ground and share updates and details so that people know they're updates in screening and why it's important they take part in checking.