Analyzing Patient Characteristics and Lung Cancer Outcomes Pre and Post the 2021 USPSTF Lung Cancer Screening Guidelines: Experience From a Large Academic Institution.

Abstract

Purpose: In 2021, the US Preventive Services Task Force (USPSTF) revised the guidelines for lung cancer screening (LCS). Numerous studies have examined the effects of the guideline changes on LCS eligibility. Yet, few have focused on their impact on participation and lung cancer outcomes within a clinical LCS cohort.

Materials and methods: This retrospective cohort study included individuals who underwent low-dose computed tomography (LDCT) screening between July 31, 2013, and August 25, 2023, at a large tertiary academic medical center. Patients were categorized into the preguideline and postguideline revision groups based on LCS eligibility and insurance status. Patient characteristics at baseline screening and lung cancer outcomes were compared.

Results: Among 3929 patients, after implementing the new guidelines, the average monthly volume of new LCS patients nearly tripled (68 vs. 23, P<0.05). Notable reductions were observed in age (mean: 63 vs. 65, P<0.05), pack-years (mean: 35 vs. 44, P<0.05), and PLCOm2012 risk score (mean: 2.9% vs. 4.1%, P<0.05). The proportion of negative LDCT results increased (89.4% vs. 84.5%, P<0.05). The proportion of Black patients decreased (5.1% vs. 6.9%, P<0.05), while Hispanic patients increased from 5.5% to 7.6% (P<0.05). The lung cancer detection rate fell in the postguideline group (0.9% vs. 4.5%, P<0.05), with 8 lung cancers detected among 943 newly eligible patients.

Conclusions: Disparities in LCS participation among racial and ethnic groups were observed following the 2021 USPSTF LCS guidelines, highlighting the need for active outreach and patient education, as guideline revisions alone increase eligibility but do not ensure participation.