P61.05 Time to Loosen Up: Liberalizing Lung Cancer Screening Guidelines Might Save More Lives

Abstract

The USPSTF recommended annual lung cancer (LC) screening with low-dose CT in current or former smoker adults, ages 55-80, with a 30 pack-year smoking history, that quit within 15 years. Other guidelines, such as NCCN, have similar criteria. In 2021, the USPSTF updated its screening guidelines, expanding the age group to adults ages 50-80 and lowering the smoking threshold to 20 or more pack-year history. We aimed to compare the screening eligibility with the new USPSTF proposed guidelines compared to the previous USPSTF LC screening guidelines in patients with LC prior to their diagnosis. We created an IRB-approved observational study. Patients who were current or former smokers diagnosed with LC between 2016 and 2019 were included in the analysis. Charts were reviewed for demographics and detailed smoking. Associations between eligibility with current and previous USPSTF screening guidelines were examined using the chi-square test. We reviewed 530 subject charts, of which 428 were included in the analysis. Of those, 186 subjects met the previous USPSTF screening criteria for LC. There were 242 subjects that were ineligible for screening according to previous USPSTF guidelines, mainly due to age and smoking history. With the newly approved USPSTF guidelines, 242 (56.5%) of the subjects would have been eligible for screening compared to the 186 (43.5%) subjects that were eligible (chi-square = 14.65, p=0.00012). [Table 1] Furthermore, 32 (37%) out of the 186 ineligible subjects under the new USPSTF recommended guidelines would have met screening criteria if all former smokers were included in the eligibility criteria regardless of their quitting date (chi-square = 5.117, p=0.023).Table 1Eligibility in old versus new USPSTF lung cancer screening guidelinesScreening Ineligible N (%)Screening Eligible N (%)P-valueOld USPSTF lung cancer screening guidelines242 (56.5)186 (43.5)p=0.000129New USPSTF lung cancer screening guidelines186 (43.5)242 (56.5) Open table in a new tab In our study, ineligible subjects mainly fail the screening criteria due to age and pack-year history of smoking. Regardless of not meeting all criteria for screening, these individuals were eventually diagnosed with cancer. Our study correlated with available data that suggests that with the current screening guidelines, individuals at high risk for lung cancer can be missed. In our study, there was a statistical association between an eligibility in subjects that would have met the more lenient currently approved guidelines. Liberalizing guidelines is associated with more high-risk subjects undergoing screening, therefore potentially increasing the rates for early detection. To improve rates of screening and overall LC mortality, organizations should continue to re-evaluate their guidelines and aim to keep expanding LC screening guidelines in attempts to improve LC mortality.