Keywords
Lung cancer; Screening; Criteria
Abstract
Background: The US Preventive Services Task Force (USPSTF) recommends screening for smokers based on age, pack-years of smoking, and years since past smokers quit (quit-time). Previous studies determined low dose computerized tomography (LDCT) to be the best method, but have not identified the population at highest risk. This study sought the percentage of lung cancer patients that would have been excluded by USPSTF criteria.
Method: A retrospective chart review identified 170past and present smokers who had undergone lung cancer resection at Hackensack Meridian Health (HMH) hospitals between September 15, 2014 and 2016. Data was collected from the Society of Thoracic Surgeons database. Descriptive statistics and Wilcoxon Rank-Sum tests were used to analyze differences between included and excluded patients.
Results: The percentage of patients that would have been excluded by screening criteria was 46.5% (95% CI: 38.8-54.3%). The difference between ages of included and excluded patients was not quite significant (p=0.051), with only17.1% (95% CI: 11.7-23.6%) of all patients excluded by age. Pack-years of included patients were significantly higher than of the excluded (p<0.001), and 25.3% (95% CI: 18.9-32.6%) had insufficient pack years. Quit-time was also a significant variable (p<0.001) and excluded 37.9% (95% CI: 29.1-49.4%) of past smokers. The percentage included by USPSTF criteria increased from 53.5% to 59.4% when quit-time was set to 25 years, and61.2% when extended to 30 years.
Conclusion: USPSTF criteria would have excluded almost half of the ever-smokers with surgically resectable lung cancers. Age would not have excluded a significant percentage, but inclusion criteria should account for smokers with less than 30 pack-years or who quit over 15 years ago. Future reviews should examine screening efficacy in larger databases. Prospective studies should investigate correlation between age and smoking history, and look to include secondhand smoking and occupational exposure as risk factors for screening.
Citation
Lee HA, Dewan AMS, Rubino KBSN, Lachica MBA, Topilow AA and Bauer TL. Percentage of Surgical Lung Cancers Missed by National Screening Criteria. J Surg Oncol Clin Res. 2017; 1(1): 1003.