While the vast majority of individuals undergoing low-dose CT (LDCT) lung cancer screening met the eligibility criteria of the United States Preventive Services Task Force (USPSTF), adherence to follow-up screening recommendations was low
90.8% of 1,159,092 individuals who entered the American College of Radiology Lung Cancer Screening Registry (LCSR) with baseline LDCT scans between 2015 and 2019 met USPSTF criteria, Medical University of South Carolina at Charleston Gerard A. Silvestri, MD, MD, and colleagues at the Annals of Internal Medicine report.
However, adherence to follow-up screening was “suboptimal” as recommended by USPSTF guidelines, with only 22.3% of screeners having follow-up scans after 12 months.
Even when the window period was extended to 24 months or more, only 34.3% and 40.3% respectively adhered to subsequent surgery – significantly lower than national lung screening A 94% compliance rate was reported for the trial on which the USPSTF recommendations are based.
“We encourage those who are screened to be largely eligible,” the authors wrote . Nonetheless, they add, “Adherence is essential – reducing adherence reduces cost-effectiveness and reduces mortality benefits. Providers should stress that LDCT is not a ‘set and forget’ test.
Considering that an estimated 8 million people in the U.S. were initially eligible for lung cancer screening when the USPSTF recommendations were first issued in 2013, Silvestri and colleagues noted, “Adherence to annual screening is high. low, which may limit its benefit on mortality.”
Silvestri’s group focused on the first 1 million people screened for lung cancer in data submitted to the LCSR by 3,625 institutions.
The authors aggregated statistics on smoking history and sociodemographic factors for these screened recipients and compared them with the 2015 National Health Interview Survey (NHIS) in line with the 2013 USPSTF screening Comparisons were made with a standard 1,257 respondents who were calculated to accurately represent the population eligible for screening in the U.S.
Compared with individuals in NHIS, in LCSR of screening recipients were older (34.7% vs 44.8% aged 65-74; prevalence [PR] 1.29, 95% CI 1.20-1.39) and more likely to be female (41.8% vs 48.1%; PR 1.15, 95% CI 1.08-1.23), more likely to be a current smoker (52.3% vs 61.4%; PR 1.17, 95% CI 1.11-1.23).
This means that Screen recipients were unlikely to be ex-smokers. “Persons who have previously smoked may be less likely to have their smoking status recorded in electronic health records and may not easily be identified as eligible for screening,” they suggest. “If patients or their practitioners quit smoking many years ago, screening may not be their primary consideration during their office visit.”
The authors also point out that while the vast majority of accepted Those screened were USPSTF compliant with 2013 criteria, but 9.2% (n=106,501) remained ineligible.
2021 update of USPSTF recommendations (reduced age standard from 55 to 50 and increased smoking standard from 30 pack-years to 20 pack-years) will increase the number of people eligible for screening to about 15 million. This means that, according to the authors’ calculations, 38.0% (n=40,426) of those who had baseline screening but did not meet the 2013 criteria would be eligible for current recommendations.
In an editorial accompanying the study, Karina W. Davidson, PhD, of the Feinstein Institute for Medical Research at Northwell Health in Manhasset, New York, noted that about 6 percent of people still received Appropriate screening, she suggests, as screening increases nationwide, “many patients may be harmed without potential benefit.”
Davidson recommends that clinicians should consult with their medical Collaboration with health systems to ensure compliance with annual follow-up screening
Whether a centralized or decentralized approach is better is still under investigation, she wrote. “More work needs to be done to determine if a dedicated nurse navigator, central database, or other tool is needed to improve the 22% annual follow-up screening rate reported in this sobering real-world registry.”
Finally, Davidson noted that the 2021 updated recommendations roughly double the eligibility of those who identify as American Indian, Alaska Native, Black or Latino. “Knowing smoking history and referring and following up this important, large and often underserved population may significantly reduce lung cancer deaths,” she wrote.
Mike Bassett is a staff writer focusing on oncology and hematology. He lives in Massachusetts.
Silvestri reports on relationships with Nucleix, Delfi and the American Cancer Society.
Several co-authors report on industry relationships.
Davidson did not disclose.