In a study reported as a research letter in JAMA Oncology, Rolle et al found increased overall adherence to the 2021 updated U.S. Preventive Services Task Force (USPSTF) lung cancer screening guidelines vs the prior guidelines. In 2021, the USPSTF updated lung cancer screening guidelines by expanding eligibility criteria to include adults between the ages of 50 and 80 years with a smoking history of at least 20 pack-years, compared with the previous criteria including adults between the ages of 55 and 80 years with a smoking history of at least 30 pack-years.
Study Details
The study used Behavioral Risk Factor Surveillance System (BRFSS) data from 2019 to2023. BRFSS is a nationally representative survey collecting health-related data from U.S. adults. The study included 17,101 survey respondents eligible for lung cancer screening according to USPSTF guidelines.
Key Findings
Among the 17,101 survey participants, 15.4% underwent lung cancer screening before the guideline changes vs 47.1% after the guideline changes.
After guideline changes, there was a statistically significant increase in the likelihood of undergoing lung cancer screening (adjusted odds ratio [OR] = 4.66, 95% confidence interval [CI] = 4.01–5.42, P < .001). Factors significantly associated with a decreased likelihood of undergoing lung cancer screening included lacking health insurance coverage (adjusted OR = 0.28, 95% CI = 0.19–0.42, P < .001), residing in rural areas (adjusted OR = 0.73, 95% CI = 0.61–0.88, P < .001), and not having a clinician (adjusted OR = 0.71, 95% CI = 0.51–1.00, P = .049).
No statistically significant interaction effects were observed for sex, race/ethnicity, income, or education levels before vs after the guideline changes. Significantly lower lung cancer screening uptake was observed after the guideline changes (P = .01 for interaction).
The investigators concluded: “In this cross-sectional study, the updated USPSTF guidelines were associated with substantially increased [lung cancer screening] uptake overall, even as cancer screenings declined during the COVID-19 pandemic. However, disparities persist, particularly among the uninsured, those without a clinician, and rural residents.”
LaShae D. Rolle, MPH, CPH, of the Department of Public Health Sciences, University of Miami Miller School of Medicine, is the corresponding author of the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
