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. 

Adults should start screening for colorectal cancer at age 45

The U.S. Preventive Services Task Force (USPSTF) recent draft recommendation statement proposed that "Adults should start screening for colorectal cancer routinely at age of 45 to 75, instead of waiting until 50 in a move that reflected the sharp rise of the number of colon and rectal cancers in young adults.

Though the vast majority of colorectal cancers are still found in the those of 50 and older, 12 percent of the 147,950 colorectal cancers that will be diagnosed this year, approximately 18,000 cases, will be found in adults under the age of 50.

The American Cancer Society in a statement issued in 2018 recommended starting at 45, after researchers found a sharp rise of the disease among young adults as young as in their 20s and 30s, including a sharp rise in rectal cancers.

The proposal by the USPSTF still must be finalised.   Its guidance on screenings and preventive care services is followed by doctors, insurance companies and policymakers.  

American Women Prefer Annual Mammograms

The US Preventive ServicesTask Force (USPSTF) reaffirmed its recommendations to screen women ages 50-74 for breast cancer every two years stating that the harms of annual screening outweighed the benefits.  It also says the decision on frequency of screening should be individualized for women ages 40-49 based on risk.  The USPSTF found insufficient evidence to recommend for or against screening for women 75 or older.

Several professional societies like the American College of Radiology and Society of Breast Imaging advocate annual screening mammography starting at age 40.

A survey of 731 women indicated that 71% of the women who were 59 years old on average said they’d prefer a screening mammogram every year. Only 17% of participants felt having biennial screening would cause less anxiety. Of the patients who reported a prior abnormal mammogram, 13% believe biennial screening would cause less anxiety

The study was presented at the 103th annual meeting of the Radiological Society of North America.

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.

New Guidelines for Colon Cancer Screening Tests.

Colorectal cancer is the second leading cause of cancer death in the United States. In 2016, an estimated 134 000 persons will be diagnosed with the disease, and about 49 000 will die from it. Colorectal cancer is most frequently diagnosed among adults aged 65 to 74 years; the median age at death from colorectal cancer is 68 years.

The United States Preventive Services Task Force (USPSTF) reviewed the evidence on the effectiveness of screening with colonoscopy, flexible sigmoidoscopy, computed tomography colonography, the guaiac-based fecal occult blood test, the fecal immunochemical test, the multi-targeted stool DNA test, and the methylated SEPT9 DNA test in reducing the incidence of and mortality from colorectal cancer or all-cause mortality; the harms of these screening tests; and the test performance their characteristics for detecting adenomatous polyps, advanced adenomas based on size, or both, as well as colorectal cancer.

The USPSTF concluded with high degree of certainty that screening for colorectal cancer in average-risk, asymptomatic adults aged 50 to 75 years is of substantial net benefit. Multiple screening strategies are available to choose from, with different levels of evidence to support their effectiveness, as well as unique advantages and limitations, although there are no data to demonstrate that any of the reviewed strategies provide a greater net benefit.

USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years (A recommendation).  Individuals should pick the screening test they feel the most comfortable with.  The decision to continue screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient’s overall health and prior screening history (C recommendation).

USPSTF breast cancer screening guidelines

The United States Preventative Services Task Force (USPSTF) issued new guidelines for when and how often women should be screened for breast cancer.

The USPSTF recommends biennial screening mammography for women 50-74 years.  Women of average risk between the ages of 40 and 49 should make an individual choice about whether to initiate screening every other year.  The UUPSTF recommends against teaching self-breast examination.

       

The USPSTF’s recommendations are similar to those issued recently by the American Cancer Society.  ACR recommends initiation of annual screening at age 45 and transition to biennial at age 55 as long as a woman has life expectancy of 10 years or longer.

USPSTF guidelines for breast cancer screening

On April 20, 2015, the U.S. Preventive Services Task Force (USPSTF) released its draft guidelines for breast cancer screening.

The USPSTF recommends biennial screening mammography for women ages 50 to 74 years.

The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.

•   For women at average risk for breast cancer, most of the benefit of mammography will result from biennial screening during ages 50 to 74 years. Of all age groups, women ages 60 to 69 years are most likely to avoid a breast cancer death through mammography screening. Screening mammography in women ages 40 to 49 years may reduce the risk of dying of breast cancer, but the number of deaths averted is much smaller than in older women and the number of false-positive tests and unnecessary biopsies are larger.

•   All women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to her health, or even apparent, during her lifetime (known as “overdiagnosis”). This risk is predicted to be increased when beginning regular mammography before age 50 years.

•   Women with a parent, sibling, or child with breast cancer may benefit more than average-risk women from beginning screening between the ages of 40 and 49 years.

•    The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women age 75 years and older.

•     The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of tomosynthesis (3-D mammography) as a screening modality for breast cancer.

This recommendation applies to asymptomatic women age 40 years and older who do not have pre-existing breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age.