Statement attributable to: Robert Smith, PhD, Senior Vice President, Cancer Screening
New USPSTF Guidelines
Final Recommendation Statement available here.
The USPSTF 2021 recommendation for annual screening for the early detection of lung cancer for those who meet the following criteria:
The two major changes from the 2013 recommendation are lowering the age to start screening from 55 to 50 and lowering the pack-year smoking history from 30 pack-years to 20 pack-years.
Significance of Changes
Despite smoking less, there is evidence that Black adults who smoke are at higher risk for lung cancer than white adults (i.e., at a lower pack-years smoking history). Lowering the pack-year history will increase the number of adults who are eligible for screening among those who currently smoke or formerly smoked, which is important for those who are at higher risk with at lower pack year histories. Similarly, Latinx/Hispanics who smoke accumulate less pack-years history than whites who smoke, and women accumulate less pack-years history than men, so more Latinx/Hispanic adults who smoke and women would be eligible for screening under the new guidelines.
Insurance Coverage
Under the ACA, all non-grandfathered private insurance plans and Medicaid expansion plans will have to provide coverage according to the new guidelines. For private insurance, the plan must begin covering the USPSTF recommended preventive service beginning in the plan year that begins on or after one year from the date the recommendation is issued. Medicare will have to choose to update its National Coverage Determination.
Current ACS Guidelines
The ACS’s lung cancer screening guideline was last updated in 2013, and an update will be initiated in 2021. The current recommendation is for annual screening for the early detection of lung cancer using a low-dose spiral computed tomography (LDCT) for those who meet the following criteria: