Impact of Revised USPSTF 2021 Lung Cancer Screening Guidelines on Long-term Cancer Survivors in the United States

Among long-term cancer survivors (those who have survived >5 years since their most recent cancer diagnosis) with a non-lung primary cancer, second primary lung cancer (SPLC) has the highest incidence (19%) and mortality rate (32%) among all secondary primary cancers. As there are no separate screening guidelines for SPLC, most providers have adopted the general US Preventive Services Task Force (USPSTF) recommendations for lung cancer screening (LCS) in cancer survivors. Results of a study that aimed to assess the differences in LCS eligibility rates among long-term cancer survivors under the USPSTF 2013 versus the revised 2021 guidelines were presented at the ESMO Congress 2023.

The study consisted of smokers aged 50 to 79 years selected from the 2017-2021 US Behavioral Risk Factor Surveillance System data. The researchers assessed the eligibility of LCS using USPSTF 2013 criteria (current or former smokers [quit ≤15 years], 55-80 years of age, and ≥30 pack-year smoking history) and the revised 2021 criteria (expanding age to 50-80 years and pack-year smoking history to 20) in long-term cancer survivors.

Among a weighted total of 17,544,768 smokers (2.7% were cancer survivors), results showed the LCS eligibility rate of long-term cancer survivors using the 2013 criteria was similar to the non-cancer survivors (21.1% vs 22.4%; P=.62) but lower when using the 2021 criteria (31.5% vs 38.0%; P=.03). The 2021 criteria increased eligibility for long-term cancer survivors across all groups (ie, women, men, non-Hispanic White and Black patients, and patients of other races). However, the degree of increase in eligibility rate in cancer survivors was lower than in non-cancer survivors.

The researchers concluded that “the increase in eligibility from the revised 2021 USPSTF appears to be less in long-term cancer survivors than in non-cancer survivors. Cancer survivors are facing a significant burden from SPLC due to their prior diagnostic tests and treatments (eg, chest irradiation), genetic susceptibility, and shared risk factors. Tailored LCS eligibility criteria are urgently needed in the growing cancer survivor population.”

Source: Wang Q. Impact of revised US Preventive Services Task Force (USPSTF) 2021 lung cancer screening guideline on long-term cancer survivors in the United States. Abstract of a poster presented at the ESMO Congress 2023; October 20-24, 2023; Madrid, Spain.