Despite USPSTF Recommendations, Lung Screening Rates Low Among Heavy Smokers

Surabhi Dangi-Garimella, PhD

A retrospective analysis conducted by researchers at the University of Louisville has found that less than 2% of the more than 7.5 million eligible smokers were screened for lung cancer in 2016 despite recommendations by the United States Preventive Services Task Force (USPSTF). These results will be presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, June 1-5, Chicago, Illinois.

“This study makes a strong case that our country needs an effective public service campaign about encouraging lung cancer screening. Public service campaigns from the 1990s encouraged women to get mammograms, saving many lives in subsequent years. We need something similar to encourage current and former heavy smokers to get screened for lung cancer,” said ASCO president Bruce E. Johnson, MD, FASCO, in a press release that described the findings from the study.

A leading cause of cancer-related mortality, lung cancer is expected to be responsible for over 154,000 deaths in the United States in 2018, according to estimates by the American Cancer Society (ACS). This disease remains the most common cancer diagnosed in both men and women.

In 2013, USPSTF rendered a B-grade recommendation for an annual lung cancer screening with low-dose computed tomography (LDCT) among adults aged 55 to 80 years who have a 30 pack-year history of smoking (defined as heavy smokers) and if they continue to smoke, or did within the past 15 years (eligible smokers). The B recommendation means USPSTF expects a moderate to substantial net benefit from the LDCT screening service.

With their current study, the authors analyzed the impact of the USPSTF recommendation on screening rates using data from the Lung Cancer Screening Registry, which was acquired from the American College of Radiology in 2016. This registry spanned 1796 accredited radiographic screening sites. The data were compared with National Health Interview Survey estimates of eligible smokers who could be screened based on the USPSTF recommendations.

The geographic grid covered the Northeast, South, Midwest, and West, and the screening rate was derived by dividing the number of LDCT scans by the number of eligible smokers.

Although the South had the most accredited screening sites (n = 663) and the highest number of eligible smokers, the screening rate in the region was the second lowest in the country (1.6%), with the West documenting the lowest screening rate (1%) as well as the fewest accredited screening sites (n = 232).

The overall national rate for screening among the potentially 7,612,965 eligible smokers was just under 2%: Only 141,260 individuals received LDCT screening.

Smoking cessation tools were offered to a significant portion (85%) of current smokers, and the authors report that the percentage of current and former smokers who were offered these tools was not influenced by the geographic location.

These results are not a surprise—a study commissioned by ACS and published in JAMA Oncology in early 2017 found that lung cancer screening rates remained low, and unchanged, following the USPSTF recommendations.

Several questions remain unanswered, according to lead study author Danh Pham, MD, a medical oncologist at the James Graham Brown Cancer Center, University of Louisville, Kentucky, who presented the results during a press cast organized by ASCO. “Are physicians not referring enough or do patients resist screening?” Pham asked. He added that there is stigma associated with this screening test, which could also be responsible for the low rates of screening.

Further initiatives are needed, including awareness programs and mandating lung cancer screening as a national quality measure, the authors conclude in their abstract. “Effective screening can prevent nearly 12,000 premature annual lung cancer deaths,” Pham said during the press cast.

Pointing out that Medicare approved payment for LDCT screening only in 2015, Johnson said that the outcome being measured by this study has not yet reached a steady state. A more long-term follow-up might provide a more realistic picture of where screening rates stand.

Pham D, Bhandari S, Oechsli M, Pinkston CM, Kloecker GH. Lung cancer screening rates: data from the lung cancer screening registry. J Clin Oncol. 2018;36(suppl; abstr 6504).
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