USPSTF Updated Lung Cancer Screening

 The U.S. Preventive Services Task Force (USPSTF) issued updated recommendations that were published in JAMA regarding screening of lung cancer.  Lung cancer is the leading cause of cancer deaths in the U.S., and the goal of expanded screening is to detect it early enough to cure it in more individuals at high risk as those who smoke.  Large studies have concluded that among people at high risk, annual CT scans can reduce the risk of death from cancer by up to 25%.  The expert panel recommended that individuals with a long history of smoking should begin receiving low-dose CT scans at age 50, five years earlier than the group recommended in 2013. 

AI Matches Radiologists in Diagnosing Lung Cancer.

 A study published in Radiology found that deep learning artificial intelligence (AI) algorithm diagnosed lung cancer from chest radiographs at a rate similar to radiologists.  The researchers tested it on 10,285 radiographs form 10,202 individuals with 10 radiographs with visible cancer.  The algorithm showed comparable sensitivity 90% to 60% for the radiologists.  In a screening cohort of 100,525 chest x-rays from 50,070 individuals with 47 radiographs with lung cancer, the algorithm's sensitivity was 83% and false positive rate was 3%.  The investigators suggested the algorithm could prove useful especially for clinicians treating healthy persons with lower prevalence of lung cancer.

Low Dose CT Lung Cancer Screening

Research by Kinsinger et al published in JAMA Internal Medicine revealed that “low dose CT scans” frequently produce false positives and demand considerable effort by both patients and requesting physicians.

The US Preventive Services Task Force recommends annual lung cancer screening (LCS) with low-dose computed tomography for current and former heavy smokers aged 55 to 80 years.

This clinical demonstration study was conducted at 8 academic VHA hospitals among 93 033 who met the criteria for LCS, 2106 agreed to undergo screening (2028 were men and 78 women; mean [SD] age, 64.9 [5.1] years).

Wide variation in processes and patient experiences occurred among the 8 sites. Of the 2106 patients screened, 1257 (59.7%) had nodules; 1184 of these patients (56.2%) required tracking, 42 (2.0%) required further evaluation but the findings were not cancer, and 31 (1.5%) had lung cancer. A variety of incidental findings, such as emphysema, other pulmonary abnormalities, and coronary artery calcification, were noted on the scans of 857 patients (40.7%).

In conclusion the research, conducted in more than 2000 high-risk VHA patients aged 55 to 80 years found lung cancer in 1.5% of patients, but around 60% of individuals who were screened had 1 or more nodules that required follow up. In addition, incidental findings were reported in around 40% of patients. It is estimated that implementation of LCS in the VHA 6.7 million patients will lead to approximately 900000 patients being eligible for LCS and will require substantial clinical effort for both patients and staff.