AAFP Updates Recommendation on Lung Cancer Screening

The updated recommendation, posted on March 31, states that the Academy supports the task force’s recommendation for annual screening for lung cancer with low-dose CT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.

The Academy further states that it reviewed the evidence published in the USPSTF’s final evidence review and determined that there was enough evidence to support a “B”-level recommendation for screening for lung cancer in adults at increased risk.

However, the AAFP acknowledges that the harms associated with annual screening with low-dose CT are not fully known at this time, and that there are numerous barriers to lung cancer screening in the community setting.

The updated recommendation also states that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

Finally, the Academy is calling for more research to determine the harms associated with screening with low-dose CT and to address barriers to care among communities of color.

Background

The Academy’s updated recommendation varies considerably from its previous recommendation on the topic, which was published in 2013.

In 2013, the AAFP did not support the USPSTF recommendation for annual screening for lung cancer with low-dose CT in adults ages 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years (also a “B”-level recommendation). Instead, the Academy expressed concern that the USPSTF’s recommendation was based primarily on the results of one study, the National Lung Screening Trial, and concluded that there was insufficient evidence to recommend for or against screening.

After the USPSTF posted the updated final statement and evidence review, the data were reviewed by the Commission on Health of the Public and Science, which recommended support. Commission chair Sarah Coles, M.D., noted that results from the Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial and other studies indicate that lung cancer screening does reduce mortality related to lung cancer, even if it doesn’t impact all-cause mortality. This is similar to recommendations for other screenings, like breast cancer screening. However, data are still needed for those populations not included in high numbers in the trials, namely women and individuals of color.

Additionally, Coles said there were concerns over the lack of evidence for screening intervals and potential issues extrapolating the trial data from university settings to the community setting, which may disproportionately impact rural and urban underserved settings and communities of color.

More Resources Available Online

The AAFP maintains a collection of preventive services recommendations on its website. Members are invited to visit the Patient Care section of AAFP.org to review the recommendations and learn more about the Academy’s guideline development process.