Lung Cancer Screening Inconsistent With U.S. Preventive Services Task Force Recommendations

• Published in: American journal of preventive medicine Vol. 56; no. 1; pp. 66 - 73
• Main Authors: Richards, Thomas B., Doria-Rose, V. Paul, Soman, Ashwini, Klabunde, Carrie N., Caraballo, Ralph S., Gray, Simone C., Houston, Keisha A., White, Mary C.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-01-2019; Elsevier Science Ltd
• Subjects: Aged; Aged, 80 and over; Chest; Cross-Sectional Studies; Early Detection of Cancer - standards; Early Detection of Cancer - statistics & numerical data; Health care policy; Health Surveys; Humans; Lung cancer; Lung Neoplasms - diagnosis; Mass Screening - standards; Mass Screening - statistics & numerical data; Medical screening; Middle Aged; Preventive medicine; Public health; Radiography, Thoracic - statistics & numerical data; Tomography; Tomography, X-Ray Computed - statistics & numerical data; Triage; X-rays; United States > US
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2018.07.030

Prior studies suggest overuse of nonrecommended lung cancer screening tests in U.S. community practice and underuse of recommended tests.
Data from the 2010 and 2015 National Health Interview Surveys was analyzed from 2016 to 2018. Prevalence, populations, and number of chest computed tomography (CT) and chest x-ray tests were estimated for people who did and did not meet U.S. Preventive Services Task Force (USPSTF) criteria for lung cancer screening, among people aged ≥40 years without lung cancer.
In 2015, among those who met USPSTF criteria, 4.4% (95% CI=3.0%, 6.6%), or 360,000 (95% CI=240,000, 535,000) people reported lung cancer screening with a chest CT; and 8.5% (95% CI=6.5%, 11.1%), or 689,000 (95% CI=526,000, 898,000) people reported a chest x ray. Among those who did not meet USPSTF criteria, 2.3% (95% CI=2.0%, 2.6%), or 3,259,000 (95% CI=2,850,000, 3,724,000) people reported a chest x ray; and 1.3% (95% CI=1.1%, 1.5%), or 1,806,000 (95% CI=1,495,000, 2,173,000) people reported a chest CT. The estimated population meeting USPSTF criteria for lung cancer screening in 2015 was 8,098,000 (95% CI=7,533,000, 8,702,000), which was smaller than the 9,620,000 people (95% CI=8,960,000, 10,325,000) in 2010.
The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to USPSTF recommendations, the prevalence of appropriate lung cancer screening is low, and the population meeting USPSTF criteria is shrinking. To realize the potential benefits of screening, better processes to appropriately triage eligible individuals to screening, plus screening with a USPSTF-recommended test, would be beneficial.