{"entity":{"id":"paper-uspstf-lung-cancer-screening-jama-2021","kind":"paper","name":"Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement","aka":[],"tldr":"In 2021 the United States task force lowered the age at which lung screening starts from 55 to 50 and halved the smoking history needed from 30 to 20 pack-years, roughly doubling the number of people eligible.","summary":"The 2021 update of the United States Preventive Services Task Force recommendation on lung cancer screening, replacing the 2013 statement. It recommends annual low-dose computed tomography in adults aged 50 to 80 years with a 20 pack-year smoking history who currently smoke or have quit within the past 15 years, a B recommendation, and says screening should stop once a person has not smoked for 15 years or develops a problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.\n\nThe widened criteria were driven by a commissioned systematic review and a collaborative modelling study, and by evidence that the 2013 thresholds excluded groups at high risk, Black smokers in particular (paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019).","asOf":"2026-09-25","links":[{"label":"JAMA 2021","url":"https://doi.org/10.1001/jama.2021.1117"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/33687470/"},{"label":"USPSTF recommendation: lung cancer screening","url":"https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening"}],"tags":["lung-evidence"],"related":["paper-nlst-nejm-2011","paper-nelson-nejm-2020","paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019","early-detection-roadmap","idea-prev-lung-screening-risk-model-eligibility"],"cancers":["lung-cancer","nsclc"],"sections":["early-detection","prevention"],"technologies":["low-dose-ct-screening"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["overdiagnosis"],"trials":[],"people":[],"bottlenecks":["b-early-detection","b-prevention-adoption","b-trial-diversity","b-global-access"],"keyPapers":[],"journals":["jama"],"dependsOn":[],"notes":[],"journal":"JAMA","year":2021,"doi":"10.1001/jama.2021.1117","pmid":"33687470","authors":"US Preventive Services Task Force, Krist AH, Davidson KW, et al.","paperType":"guideline","findings":["Annual low-dose computed tomography is recommended for adults aged 50 to 80 with a 20 pack-year smoking history who currently smoke or quit within the past 15 years (B recommendation).","This replaces the 2013 statement, which recommended screening from age 55 with a 30 pack-year history.","The task force concludes with moderate certainty that annual low-dose computed tomography has a moderate net benefit in people at high risk based on age, cumulative tobacco exposure and years since quitting.","The statement quotes an estimated 228,820 lung cancer diagnoses and 135,720 deaths in the United States in 2020, and an overall five-year survival of 20.5 percent."],"whatItMeans":"The document that defines who is offered a scan in the United States, and therefore the document any argument about the screening eligibility gap has to engage with. Eligibility is still defined by pack-years and years since quitting rather than by an individual risk estimate.","caveats":["Pack-year thresholds are a crude proxy for risk and perform differently across populations; risk-model eligibility was considered in the modelling but not adopted.","Never-smokers are outside the recommendation entirely, so the growing never-smoker disease is not addressed.","A recommendation is not delivery: uptake among eligible people in the United States has remained a small fraction of those covered.","United Kingdom eligibility, the Targeted Lung Health Check programme and NICE positions are on the UK and NHS page for lung cancer and are not restated here."],"changedPractice":true},"route":"/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/","neighbours":{"paper":[{"id":"paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019","kind":"paper","name":"Evaluation of USPSTF Lung Cancer Screening Guidelines Among African American Adult Smokers","route":"/key-papers/paper-aldrich-uspstf-screening-african-american-smokers-jama-oncol-2019/"},{"id":"paper-nelson-nejm-2020","kind":"paper","name":"NELSON: volume-based CT screening reduces lung cancer deaths with fewer false alarms","route":"/key-papers/paper-nelson-nejm-2020/"},{"id":"paper-nlst-nejm-2011","kind":"paper","name":"NLST: yearly low-dose CT scans cut lung cancer deaths in heavy smokers","route":"/key-papers/paper-nlst-nejm-2011/"},{"id":"paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013","kind":"paper","name":"Socioeconomic inequalities in lung cancer treatment: systematic review and meta-analysis","route":"/key-papers/paper-forrest-socioeconomic-inequalities-lung-cancer-treatment-plos-med-2013/"}],"roadmap":[{"id":"early-detection-roadmap","kind":"roadmap","name":"Early detection roadmap: organ screening → blood tests for many cancers","route":"/roadmaps/early-detection-roadmap/"},{"id":"lung-cancer-evidence-roadmap","kind":"roadmap","name":"Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch","route":"/roadmaps/lung-cancer-evidence-roadmap/"}],"idea":[{"id":"idea-lung-uk-screening-testing-and-access-gaps","kind":"idea","name":"Close the United Kingdom lung cancer gaps the UK page names: screening rollout, diagnostic pathway, molecular testing and drug access","route":"/ideas/idea-lung-uk-screening-testing-and-access-gaps/"},{"id":"idea-lung-screening-eligibility-by-risk-not-pack-years","kind":"idea","name":"Decide who is screened for lung cancer by individual risk, not by pack-years","route":"/ideas/idea-lung-screening-eligibility-by-risk-not-pack-years/"},{"id":"idea-prev-lung-screening-risk-model-eligibility","kind":"idea","name":"Lung screening eligibility by risk score, not pack-years, including high-risk never-smokers","route":"/ideas/idea-prev-lung-screening-risk-model-eligibility/"},{"id":"idea-lung-never-smoker-disease-its-own-programme","kind":"idea","name":"Treat lung cancer in never-smokers as its own disease, with its own detection programme","route":"/ideas/idea-lung-never-smoker-disease-its-own-programme/"},{"id":"idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery","kind":"idea","name":"Treat the deprivation gradient in lung cancer as a defect in delivery that can be fixed and measured","route":"/ideas/idea-lung-deprivation-gradient-treated-as-a-defect-in-delivery/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"},{"id":"prevention","kind":"section","name":"Prevention & Risk","route":"/fronts/prevention/"}],"technology":[{"id":"low-dose-ct-screening","kind":"technology","name":"Low-dose CT lung screening","route":"/technologies/low-dose-ct-screening/"}],"term":[{"id":"overdiagnosis","kind":"term","name":"Overdiagnosis","route":"/terms/overdiagnosis/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-prevention-adoption","kind":"bottleneck","name":"Prevention we already have is not deployed","route":"/bottlenecks/b-prevention-adoption/"},{"id":"b-early-detection","kind":"bottleneck","name":"The hardest cancers are found late","route":"/bottlenecks/b-early-detection/"},{"id":"b-trial-diversity","kind":"bottleneck","name":"Trials do not represent the people who get cancer","route":"/bottlenecks/b-trial-diversity/"}],"journal":[{"id":"jama","kind":"journal","name":"JAMA","route":"/journals/jama/"}]}}