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March 9, 2021

The 2021 US Preventive Services Task Force Recommendation on Lung Cancer Screening: The More Things Stay the Same…

Author Affiliations
  • 1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester
  • 2Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
  • 3Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester
  • 4Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts
  • 5Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
  • 6Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon
  • 7Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health & Science University, Portland
  • 8Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon
JAMA Oncol. 2021;7(5):684-686. doi:10.1001/jamaoncol.2020.8376
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The United States Preventive Services Task Force (USPSTF) recently updated its recommendation statement regarding lung cancer screening (LCS) using low-dose computed tomography (LDCT).1 This update was based on a systematic evidence synthesis,2 including review of more than 220 publications, and informed by extensive decision analysis modeling by the Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Cancer Working Group.3 As with its 2013 statement,4 the USPSTF gave LCS a B recommendation, meaning its consensus was that there is moderate certainty that annual screening for lung cancer with LDCT is of moderate net benefit.1 Key changes from the 2013 statement include expansion of the recommended eligibility criteria to begin screening at age 50 years instead of 55 years and requiring 20 rather than 30 pack-years total firsthand cigarette smoke exposure. There was no change in the remaining recommendations, such as the modality and frequency of screening or when to discontinue LCS, and the USPSTF kept risk-factor eligibility criteria rather than switching to criteria determined by risk model.

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    1 Comment for this article
    The remarkable absence of "Radon" in the updated lung cancer screening guidelines and editorial commentary concening them
    Achim Lohse, B.A. | n/a
    Upon reviewing the recent report on the updated screening guidelines in the USA and on the editorial comments thereon, I'm astonished that word search turns up not a single mention of "Radon" in any of these texts. Yet radon appears to be universally rated as the second cause of lung cancer after smoking, with a mortality estimated at 3 to 30%.

    If one accepts the credibility of evidence supporting claims of lung cancer mortality caused by residential radon exposure, how can one hope to credibly assess the need of former smokers for screening without considering the effect of past
    and/or current radon exposure?