Population-Level Trends in Lung Cancer Mortality and Stage Distribution During the USPSTF LDCT Guideline Era: A...

Area of Science:

• Public Health
• Epidemiology
• Cancer Screening

Background:

• The U.S. Preventive Services Task Force (USPSTF) recommended low-dose computed tomography (LDCT) screening for lung cancer in 2013.
• Assessing population-level impacts of this recommendation is crucial for understanding screening effectiveness.

Purpose of the Study:

• To evaluate temporal changes in lung cancer incidence, stage at diagnosis, and mortality among adults aged 55-79 years before and after the 2013 USPSTF LDCT screening recommendation.

Main Methods:

• Utilized US CDC WONDER, Global Burden of Disease (GBD), and SEER data to analyze age-adjusted incidence (AAIR) and mortality (AAMR) trends.
• Employed joinpoint regression and interrupted time-series (ITS) models to assess pre- and post-2014 changes.
• Conducted counterfactual analyses to estimate differences between observed outcomes and projected trends based on pre-2014 data.

Main Results:

• Accelerated declines in lung cancer mortality and incidence were observed post-2014 across multiple data systems.
• SEER data indicated a higher proportion of localized-stage diagnoses and fewer distant-stage diagnoses after 2014.
• Counterfactual models estimated significant reductions in observed deaths compared to projections based on pre-2014 trends.

Conclusions:

• Independent national datasets demonstrate accelerated mortality declines and a shift toward earlier-stage lung cancer diagnoses during the USPSTF LDCT guideline era.
• These findings are consistent with potential real-world benefits of LDCT screening.
• Results should be interpreted considering concurrent reductions in smoking, screening uptake, and therapeutic advancements.