The American Cancer Society (ACS) has released an updated lung cancer screening (LCS) guideline, significantly increasing eligibility and bringing it into concordance with the U.S. Preventive Services Task Force's (USPSTF) recommendation released in 2021.
Published November 1 in CA: A Cancer Journal for Clinicians, the new guidance expands eligibility to include five million more U.S. adults compared to the previous 2013 recommendation, the ACS said. It urges yearly screening for lung cancer via low-dose CT (LDCT) exams for people aged 50 to 80 years old who are current or former smokers and have a 20-year or greater pack-year history.
"This updated guideline continues a trend of expanding eligibility for lung cancer screening in a way that will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early," Dr. Robert Smith, senior vice president, early cancer detection science at the ACS and lead author of the lung cancer screening guideline report said in a press conference. "Recent studies have shown extending the screening age for persons who smoke and formerly smoked, eliminating the 'years since quitting' requirement and lowering the pack per year recommendation could make a real difference in saving lives."
Lung cancer is the overall leading cause of cancer death in the United States and is the second most frequently diagnosed malignancy in both men and women, according to the ACS. This year, the society estimates that 238,340 new cases of lung will be diagnosed and about 127,070 people will die from the disease.
To update its guidance, the ACS used data from a systematic review of lung cancer screening with LDCT that was performed in 2021 for the USPSTF by the Research Triangle Institute (RTI) International-University of North Carolina at Chapel Hill Evidence‐based Practice Center. Its 2023 recommendation differs from the previous 2013 version in the following ways:
| Differences in ACS 2023 lung cancer screening guidance compared with 2013 | ||
|---|---|---|
| Factor | 2013 recommendation | 2023 recommendation |
| Age for eligibility | 55 to 74 years | 50 to 80 years |
| Pack-year history | 30+ | 20+ |
| Years since quitting | ≤ 15 | No longer required for screening |
The society also stressed that adults with health conditions that limit life expectancy or affect their ability or willingness to get lung cancer treatment if diagnosed should not be screened for the disease.
"The principal benefit of LCS is a reduction in lung cancer‐specific deaths," the ACS noted. "[Randomized controlled trials] have provided a foundation of evidence that LCS with LDCT is efficacious, and the diagnostic accuracy studies support that it has high sensitivity and acceptable specificity for the early detection of lung cancer in persons judged to be at high risk due to smoking history."
Quitting smoking is key to reducing lung cancer risk, and efforts should be made to support individuals in this endeavor, Smith said.
"The good news is our research shows the number of new lung cancer cases diagnosed each year continues to decrease, partly because more people are quitting smoking (or not starting)," he noted. "The number of deaths from lung cancer continues to drop as well, due to fewer people smoking and advances in early detection and treatment, but we still have to do better. This updated guideline is a step in the right direction."
The complete guidance can be found here.
