Study suggests need for more sensitive lung cancer screening criteria

An analysis of lung cancer incidence and screening found a decline in the proportion of patients with lung cancer meeting high-risk screening criteria, suggesting that an increasing number of patients with lung cancer would not have been candidates for screening, according to a study in the February 24 issue of JAMA.

Lung cancer screening using low-dose computed tomography is recommended for high-risk individuals by professional associations, including the U.S. Preventive Services Task Force (USPSTF). Ping Yang M.D., Ph.D., of the Mayo Clinic, Rochester, Minn., and colleagues conducted a study to examine the trends in the proportion of patients with lung cancer meeting the USPSTF screening criteria.

The study population included all Olmsted County, Minn., residents older than 20 years from 1984 through 2011, comprising approximately 140,000 people, of whom 83 percent were non-Hispanic white and socioeconomically similar to the general Midwestern U.S. population. All pathologically confirmed incident cases of primary lung cancer were identified using the Rochester Epidemiology Project database. Trends in lung cancer incidence rates were determined based on census data adjusted for the age and sex distribution of the U.S. population in 2000. The proportion of cases meeting USPSTF screening criteria were identified. The criteria included asymptomatic adults 55 to 80 years of age, having a 30 pack-year (a measure of cigarette consumption equivalent to smoking one pack a day for a year) smoking history, and currently smoking or having quit within the past 15 years.

There were 1,351 patients with a new diagnosis of primary lung cancer between 1984 and 2011. The proportion of patients with lung cancer who smoked more than 30 pack-years declined, and the proportion of former smokers, especially those who quit smoking more than 15 years ago, increased. The researchers found there was a decline in the relative proportion of patients with lung cancer meeting the USPSTF criteria overall, from 57 percent in 1984-1990 to 43 percent in 2005-2011. The proportion of patients who would have been eligible under the criteria decreased among women from 52 percent to 37 percent, and from 60 percent to 50 percent among men.

"Our findings may reflect a temporal change in smoking patterns in which the proportion of adults with a 30 pack-year smoking history and having quit within 15 years declined," the authors write.

Guidelines recommending annual low-dose CT lung cancer screening for older smokers have been approved by the US Preventive Services Task Force. The recommendations apply to individuals aged between 55 and 80 who are at high risk for lung cancer as a result of heavy smoking.

The guidelines are published in the journal Annals of Internal Medicine.

According to the American Cancer Society, approximately 228,190 new cases of lung cancer will have been diagnosed during 2013, with 159,480 deaths from the disease. This accounts for around 27% of all cancer deaths.