Uniformed Services University of the Health Sciences, Bethesda, MD (Drs. Covey and Cagle); David Grant Medical Center, Travis Air Force Base, Fairfield, CA (Dr. Covey); Ehrling Burquist Clinic, Offutt Air Force Base, Bellevue, NE (Dr. Cagle) carlcovey24@gmail.com
The authors reported no potential conflict of interest relevant to this article.
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Uniformed Services University, Department of the Air Force, Department of Defense, nor the US government.
As a result, the USPSTF now recommends annual lung cancer screening with LDCT for any adult ages 50 to 80 years who has a 20-pack-year smoking history and currently smokes or has quit within the past 15 years.6 Screening should be discontinued once a person has not smoked for 15 years, develops a health problem that substantially limits life expectancy, or is not willing to have curative lung surgery.6
Expanding the screening eligibility may also address racial and gender disparities in health care. Black people and women who smoke have a higher risk for lung cancer at a lower intensity of smoking.6
Following the USPSTF update, the American College of Chest Physicians and the Centers for Medicare and Medicaid Services published updated guidance that aligns with USPSTF’s recommendations to lower the age and pack-year qualifications for initiating screening.7,10 The American Cancer Society is currently reviewing its 2018 guidelines on lung cancer screening.14TABLE 16-10 summarizes the guidance on lung cancer screening from these medical societies.
Effective screening could save lives (and money)
A smoker’s risk for lung cancer is 20 times higher than that of a nonsmoker15,16; 55% of lung cancer deaths in women and 70% in men are attributed to smoking.17 Once diagnosed with lung cancer, more than 50% of people will die within 1 year.1 This underpins the need for a lung cancer screening modality that reduces mortality. Large RCTs, including the NLST and NELSONtrials, have shown that screening high-risk individuals with LDCT can significantly reduce lung cancer–related death when compared to no screening or screening with CXR alone.11,13
There is controversy surrounding the cost benefit of implementing a nationwide lung cancer screening program. However, recent use of microsimulation models has shown LDCT to be a cost-effective strategy, with an average cost of $81,000 per quality-adjusted life-year, which is below the threshold of $100,000 to be considered cost effective.18 Expanding the upper age limit for screening leads to a greater reduction in mortality but increases treatment costs and overdiagnosis rates, and overall does not improve quality-adjusted life-years.18
