The 2021 US Preventive Services Task Force Lung Cancer Screening Criteria Miss Many Patients Diagnosed with Early- and Late-Stage Lung Cancer: Analysis of Three Cohort Studies.

Abstract

Lung cancer screening (LCS) aims to detect lung cancers-that have historically been diagnosed at late stages-at earlier stages when the likelihood of cure is high. However, the proportion of individuals diagnosed with late-stage lung cancer in the U.S. who would have qualified for LCS is unknown. What proportion of individuals diagnosed with early-stage versus late-stage lung cancer would have qualified for LCS under the 2021 U.S. Preventive Services Task Force (USPSTF) recommendation? Participants diagnosed with lung cancer in the Boston Lung Cancer Study (BLCS), a cancer epidemiology cohort study in Boston, MA, as well as the Southern Community Cohort Study (SCCS) and Multiethnic Cohort Study (MECS), two large-scale U.S. prospective cohort studies, were identified. In each cohort, we grouped participants according to whether they were diagnosed with early-stage or late-stage lung cancer. The proportion of participants with late-stage lung cancer eligible under the 2021 USPSTF recommendation was evaluated and compared to that among participants with early-stage lung cancer. A total of 7,017 participants in the BLCS, 1,807 in the SCCS, and 5,681 in the MECS were included. Among participants with late-stage lung cancer, the proportion eligible under the 2021 USPSTF recommendation was 41.2% in the BLCS, 58.9% in the SCCS, and 41.4% in the MECS. Similar proportions of participants diagnosed with early-stage versus late-stage lung cancer met the USPSTF criteria in each cohort. The most common reason for ineligibility among both groups of participants was smoking <20-pack-years in the SCCS and MECS and stopping smoking >15 years ago in the BLCS. In this analysis of nearly 15,000 participants with lung cancer, only 41-59% of participants with late-stage lung cancer would have met the 2021 USPSTF recommendation; similar proportions of participants with early-stage lung cancer would have met the 2021 USPSTF recommendation.