NCHR’s Public Comments on USPSTF’s Draft Recommendation Statement Regarding Lung Cancer Screening

August 3, 2020

We are writing to express our views on the U.S. Preventive Services Task Force’s (USPSTF) draft recommendation statement regarding lung cancer screening. 

The National Center for Health Research is a nonprofit think tank that conducts, analyzes, and scrutinizes research on a range of health issues, with particular focus on which prevention strategies and treatments are most effective for which patients and consumers. We do not accept funding from companies that make products that are the subject of our work, so we have no conflicts of interest.

Although we agree that the evidence suggests that the recommended changes in screening ages and pack-year history will lead to fewer lung cancer deaths, it is important to note that evidence is inconsistent regarding whether lung cancer screening with low-dose computed tomography (LDCT) will improve overall survival. There are other potentially fatal diseases caused by smoking in addition to lung cancer, which is why overall survival is the most important outcome measure. In addition, the screening itself carries risks, especially when a false positive result leads to an unnecessary biopsy, which can itself be harmful. While we generally support the ‘B’ rating for the recommendation regarding annual screening for lung cancer with LDCT, this seems to be mainly appropriate for younger adults and those without comorbidities. Since the evidence for screening in older patients, as well as those with serious comorbidities does not support a ‘B’ rating, we urge USPSTF to carefully examine the data for these two groups and develop different recommendations for them.  

While we commend the efforts to decrease racial and sex disparities in lung cancer mortality by lowering the age range and amount of pack-years that are eligible for screening, we strongly urge the USPSTF to specifically analyze available data to determine whether the proposed changes in eligibility criteria will reduce these disparities. Although the USPSTF apparently presumes that lowering the age range and amount of pack-years for eligibility will lead to detecting cancers at an earlier stage that can be treated more effectively, no data were provided to determine how changing the proposed screening eligibility criteria would affect overall survival for women or African Americans. We also suggest that USPSTF consider whether the benefits of LDCT screening outweighs the risks for people over 75.

We strongly commend USPSTF’s recommendation that healthcare providers and patients engage in shared decision-making regarding screening, stating that there should be a thorough discussion regarding the potential benefits, limitations, and harms of screening. We also strongly endorse USPSTF’s recommendation that physicians provide resources for smoking cessation and that all current smokers enrolled in a screening program should receive smoking cessation interventions. We urge USPSTF to recommend that those resources be easily available and user friendly.