House punts on AI with directionless new task force
The House of Representatives has founded a Task Force on artificial intelligence that will “ensure America continues leading in this strategic area,” as Speaker Mike Johnson put it. But the announcement feels more like a punt after years of indecision that show no sign of ending.
In a way this task force — chaired by California Reps Ted Lieu and Jay Obernolte — is a welcome sign of Congress doing something, anything, on an important topic that has become the darling of tech investment. But in another, more important way, it comes off as lip service at a time many feel AI and tech are running circles around regulators and lawmakers.
Furthermore, the dispiriting partisanship and obstruction on display every day in Congress renders quaint any notion that this task force would produce anything of value at any time, let alone during a historically divisive election year.
“As new innovations in AI continue to emerge, Congress and our partners in federal government must keep up. House Republicans and Democrats will work together to create a comprehensive report detailing the regulatory standards and congressional actions needed to both protect consumers and foster continued investment and innovation in AI,” said Rep. Obernolte in the announcement.
And Rep. Lieu: “AI has the capability of changing our lives as we know it. The question is how to ensure AI benefits society instead of harming us. As a recovering Computer Science major, I know this will not be an easy or quick or one-time task, but I believe Congress has an essential role to play in the future of AI. I have been heartened to see so many Members of Congress of all political persuasions agree.”
Of course, the White House , numerous agencies , the EU and countless other authorities and organizations are already issuing “comprehensive reports” and recommending legislative actions, but what’s one more?
Feds kick off National AI Research Resource with pilot program live today
It seems as though Congress realized that it was the last substantive entity to act on this industry-reshaping force, and so representatives reached across the aisle to pat each other on the back for taking the smallest possible step toward future legislation.
But at the same time, with Congress dysfunctional (having passed a historically low number of bills) and all eyes on the 2024 presidential election, this task force is just a way of kicking the can down the road until they know what they can get away with under the coming administration.
Certainly studying AI and its risks and benefits is not a bad thing — but it’s a little late in the day to be announcing it. This task force is long overdue, and as such we may welcome it but also treat it with the same skepticism that lawmaker pandering deserves.
Everyone involved with this will point to it when asked why they haven’t acted on AI, which many voters fear is coming for their jobs or automating processes that once had a purposeful human touch. “But we started this task force!” Yes, and the EU has had their task force working on this subject since the pandemic days.
The announcement of the task force kept expectations low, with no timeline or deliverables that voters or watchdogs can hold them to. Even the report is something they will only “seek” to produce!
Furthermore, considering the expert agencies are at risk of declawing via Supreme Court decision , it is hard to even imagine what a regulatory structure would look like a year from now. Want the FTC, FCC, SEC, EPA or anyone else to help out? They may be judicially restrained from doing so come 2025.
Perhaps this task force is Congress’s admission that during such tumultuous times, and lacking any real insight into an issue, all they can do is say “we’ll look into it.”
House leaders launch bipartisan artificial intelligence task force
WASHINGTON — Senate Majority Leader Chuck Schumer, D-N.Y., has convened high-profile forums on artificial intelligence for months. Now, the two leaders of the House are getting in on the action as lawmakers struggle to regulate the fast-moving technology.
Speaker Mike Johnson, R-La., and Minority Leader Hakeem Jeffries, D-N.Y., said Tuesday that they are launching a bipartisan task force on artificial intelligence (AI) to explore how Congress can help America be a leader in AI innovation and to study guardrails to protect against potential threats caused by the technology, including deepfakes, the spread of misinformation, and job replacement.
The two House leaders have each appointed 12 members to the task force. It will be led by two Californians with computer science backgrounds: Chairman Jay Obernolte, a Republican who earned his master’s degree in AI and owns a video game development company, and Co-Chairman Ted Lieu, a member of the Democratic leadership team who last year wrote a bill to regulate AI using the AI chatbot ChatGPT.
Both Obernolte and Lieu were featured in an NBC News story last year where they warned their colleagues to take seriously the threats posed by AI while acknowledging that Congress has failed to impose regulations on powerful social media companies.
The new task force will tasked with writing a comprehensive report that will include guiding principles, recommendations and policy proposals developed with help from House committees of jurisdiction, the leaders said.
“Because advancements in artificial intelligence have the potential to rapidly transform our economy and our society, it is important for Congress to work in a bipartisan manner to understand and plan for both the promises and the complexities of this transformative technology,” Johnson said in a statement.
“As we look to the future, Congress must continue to encourage innovation and maintain our country’s competitive edge, protect our national security, and carefully consider what guardrails may be needed to ensure the development of safe and trustworthy technology.”
Jeffries added: “Congress has a responsibility to facilitate the promising breakthroughs that artificial intelligence can bring to fruition and ensure that everyday Americans benefit from these advancements in an equitable manner."
“The rise of artificial intelligence also presents a unique set of challenges and certain guardrails must be put in place to protect the American people,” he continued. “Congress needs to work in a bipartisan way to ensure that America continues to lead in this emerging space, while also preventing bad actors from exploiting this evolving technology.”
In addition to Obernolte, the other Republicans are: Reps. Neal Dunn, Kat Cammack, Scott Franklin and Laurel Lee, all of Florida; Darrell Issa and Michelle Steel, both of California; French Hill of Arkansas; Michael Cloud of Texas; Ben Cline of Virginia; Eric Burlison of Missouri; and Rich McCormick of Georgia.
In addition to Lieu, the other Democrats are: Reps. Anna Eshoo, Ami Bera and Sara Jacobs, all of California; Yvette Clarke and Alexandria Ocasio-Cortez, both of New York; Bill Foster of Illinois; Suzanne Bonamici of Oregon; Don Beyer of Virginia; Haley Stevens of Michigan; Valerie Foushee of North Carolina; and Brittany Pettersen of Colorado.
Separately, another Californian, Democratic Rep. Ro Khanna hosted an AI forum on Capitol Hill on Feb. 15 focused on worker equity, deception and manipulation using AI, and preparing American society, specifically children, for an AI-integrated world.
Participants included AI scholars, labor leaders and the science fiction writer Ted Chiang.
Scott Wong is a senior congressional reporter for NBC News.
- Truth Social
House Launches Bipartisan Task Force on Artificial Intelligence
February 20, 2024
For Immediate Release
Contact: Athina Lawson
WASHINGTON — Speaker Mike Johnson and Democratic Leader Hakeem Jeffries announced the establishment of a bipartisan Task Force on Artificial Intelligence (AI) to explore how Congress can ensure America continues to lead the world in AI innovation while considering guardrails that may be appropriate to safeguard the nation against current and emerging threats.
Speaker Johnson and Leader Jeffries have each appointed twelve members to the Task Force that represent key committees of jurisdiction and will be jointly led by Chair Jay Obernolte (CA-23) and Co-Chair Ted Lieu (CA-36). The Task Force will seek to produce a comprehensive report that will include guiding principles, forward-looking recommendations and bipartisan policy proposals developed in consultation with committees of jurisdiction.
“Because advancements in artificial intelligence have the potential to rapidly transform our economy and our society, it is important for Congress to work in a bipartisan manner to understand and plan for both the promises and the complexities of this transformative technology,” said Speaker Mike Johnson . “I am happy to announce with Leader Jeffries this new Bipartisan Task Force on Artificial Intelligence to ensure America continues leading in this strategic arena.
“Led by Rep. Jay Obernolte (R-Ca.) and Rep. Ted Lieu (D-Ca.), the Task Force will bring together a bipartisan group of Members who have AI expertise and represent the relevant committees of jurisdiction. As we look to the future, Congress must continue to encourage innovation and maintain our country’s competitive edge, protect our national security, and carefully consider what guardrails may be needed to ensure the development of safe and trustworthy technology.”
“Congress has a responsibility to facilitate the promising breakthroughs that artificial intelligence can bring to fruition and ensure that everyday Americans benefit from these advancements in an equitable manner,” said Democratic Leader Hakeem Jeffries . “That is why I am pleased to join Speaker Johnson in announcing the new Bipartisan Task Force on Artificial Intelligence, led by Rep. Ted Lieu and Rep. Jay Obernolte.
“The rise of artificial intelligence also presents a unique set of challenges and certain guardrails must be put in place to protect the American people. Congress needs to work in a bipartisan way to ensure that America continues to lead in this emerging space, while also preventing bad actors from exploiting this evolving technology. The Members appointed to this Task Force bring a wide range of experience and expertise across the committees of jurisdiction and I look forward to working with them to tackle these issues in a bipartisan way.”
“It is an honor to be entrusted by Speaker Johnson to serve as Chairman of the House Task Force on Artificial Intelligence,” said Chair Jay Obernolte (CA-23) . “As new innovations in AI continue to emerge, Congress and our partners in federal government must keep up. House Republicans and Democrats will work together to create a comprehensive report detailing the regulatory standards and congressional actions needed to both protect consumers and foster continued investment and innovation in AI.
“The United States has led the world in the development of advanced AI, and we must work to ensure that AI realizes its tremendous potential to improve the lives of people across our country. I look forward to working with Co-Chair Ted Lieu and the rest of the Task Force on this critical bipartisan effort.”
“Thank you to Leader Jeffries and Speaker Johnson for establishing this bipartisan House Task Force on Artificial intelligence. AI has the capability of changing our lives as we know it. The question is how to ensure AI benefits society instead of harming us. As a recovering Computer Science major, I know this will not be an easy or quick or one-time task, but I believe Congress has an essential role to play in the future of AI. I have been heartened to see so many Members of Congress of all political persuasions agree,” said Co-Chair Ted Lieu (CA-36) .
“I am honored to join Congressman Jay Obernolte in leading this Task Force on AI, and honored to work with the bipartisan Members on the Task Force. I look forward to engaging with Members of both the Democratic Caucus and Republican Conference, as well as the Senate, to find meaningful, bipartisan solutions with regards to AI.”
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Biden’s Climate Task Force Opens for Business, Aiming to Restore ‘Credibility’
The high-level group’s first meeting focused on job creation and reducing greenhouse gas emissions.
By Lisa Friedman
WASHINGTON — Vice President Kamala Harris and White House aides convened cabinet secretaries and the acting heads of 21 federal agencies on Thursday to begin fulfilling President Biden’s promise to mobilize the entire federal government to confront climate change.
Gina McCarthy, who heads the White House office of climate policy, said Thursday’s meeting focused on job-creation as well as ensuring that agency leaders understood their role in helping to set an aggressive new target for cutting the United States’ share of global emissions. The Biden administration wants to announce those goals on April 22.
“Over the past four years we have not earned a lot of credibility on climate,” Ms. McCarthy, who led Thursday’s meeting, said in an interview, adding, “It’s time we turn that around.”
The National Climate Task Force, which Mr. Biden created as part of a series of executive actions during his first week in office, is meant to meet regularly to chart progress on a series of administration goals including eliminating fossil fuel emissions from the electricity sector by 2035; transitioning federal, state and local government fleets to zero-emissions vehicles; and increasing conservation while also increasing renewable energy production on public land and waters.
Mr. Biden campaigned on a pledge to reach net-zero emissions across the economy before 2050, and to eliminate fossil fuel pollution from the electricity sector by 2035.
Mr. Biden has made the case that tackling climate change by focusing on building clean energy infrastructure will bring economic recovery and create “millions” of new jobs — a goal economists said faces serious challenges .
At Thursday’s meeting the task force started a new working group to focus on specific challenges, such as creating energy storage at a fraction of the current cost and developing sustainable fuels for aircraft and ships. The administration announced $280 million in combined Energy and Transportation Department grant opportunities for technology development.
The talks took place via Zoom among about 50 people, including Treasury Secretary Janet Yellen and Transportation Secretary Pete Buttigieg, as well as deputies for agencies still waiting for the Senate to confirm their leaders, such as the Environmental Protection Agency and the Interior Department.
Ali A. Zaidi, the White House deputy national climate adviser, said the goal was a “redefinition of the way government can operate in the face of great crises,” like climate change.
Former Secretary of State John Kerry, now Mr. Biden’s global envoy for climate change , spoke to the task force about the upcoming international negotiations in which the United States, which once again is part of the Paris Agreement, will take part.
The Obama administration pledged to cut America’s emissions up to 28 percent below 2005 levels by 2025. Former President Donald J. Trump withdrew from the Paris accord and ended all federal efforts to try to meet that target, leaving the country about halfway to the goal. Mr. Biden will be expected to put forward an even more aggressive goal that he believes the nation can meet by 2030.
The administration intends to announce that new emissions target at a global leaders’ climate summit that it will host on April 22.
“We’re going to look at every opportunity we have to capture the reductions we can defend,” Ms. McCarthy said.
Lisa Friedman reports on federal climate and environmental policy from Washington. She has broken multiple stories about the Trump administration’s efforts to repeal climate change regulations and limit the use of science in policymaking. More about Lisa Friedman
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HOUSE LAUNCHES BIPARTISAN TASK FORCE ON ARTIFICIAL INTELLIGENCE
WASHINGTON — Speaker Mike Johnson and Democratic Leader Hakeem Jeffries announced the establishment of a bipartisan Task Force on Artificial Intelligence (AI) to explore how Congress can ensure America continues to lead the world in AI innovation while considering guardrails that may be appropriate to safeguard the nation against current and emerging threats. Speaker Johnson and Leader Jeffries have each appointed twelve members to the Task Force that represent key committees of jurisdiction and will be jointly led by Chair Jay Obernolte (CA-23) and Co-Chair Ted Lieu (CA-36). The Task Force will seek to produce a comprehensive report that will include guiding principles, forward-looking recommendations and bipartisan policy proposals developed in consultation with committees of jurisdiction. “Because advancements in artificial intelligence have the potential to rapidly transform our economy and our society, it is important for Congress to work in a bipartisan manner to understand and plan for both the promises and the complexities of this transformative technology,” said Speaker Mike Johnson. “I am happy to announce with Leader Jeffries this new Bipartisan Task Force on Artificial Intelligence to ensure America continues leading in this strategic arena. “Led by Rep. Jay Obernolte (R-Ca.) and Rep. Ted Lieu (D-Ca.), the task force will bring together a bipartisan group of Members who have AI expertise and represent the relevant committees of jurisdiction. As we look to the future, Congress must continue to encourage innovation and maintain our country’s competitive edge, protect our national security, and carefully consider what guardrails may be needed to ensure the development of safe and trustworthy technology.” “Congress has a responsibility to facilitate the promising breakthroughs that artificial intelligence can bring to fruition and ensure that everyday Americans benefit from these advancements in an equitable manner,” said Democratic Leader Hakeem Jeffries. “That is why I am pleased to join Speaker Johnson in announcing the new Bipartisan Task Force on Artificial Intelligence, led by Rep. Ted Lieu and Rep. Jay Obernolte.” “The rise of artificial intelligence also presents a unique set of challenges and certain guardrails must be put in place to protect the American people. Congress needs to work in a bipartisan way to ensure that America continues to lead in this emerging space, while also preventing bad actors from exploiting this evolving technology. The Members appointed to this Task Force bring a wide range of experience and expertise across the committees of jurisdiction and I look forward to working with them to tackle these issues in a bipartisan way.” “It is an honor to be entrusted by Speaker Johnson to serve as Chairman of the House Task Force on Artificial Intelligence,” said Chair Jay Obernolte (CA-23). “As new innovations in AI continue to emerge, Congress and our partners in federal government must keep up. House Republicans and Democrats will work together to create a comprehensive report detailing the regulatory standards and congressional actions needed to both protect consumers and foster continued investment and innovation in AI.” “The United States has led the world in the development of advanced AI, and we must work to ensure that AI realizes its tremendous potential to improve the lives of people across our country. I look forward to working with Co-Chair Ted Lieu and the rest of the Task Force on this critical bipartisan effort.” “Thank you to Leader Jeffries and Speaker Johnson for establishing this bipartisan House Task Force on Artificial intelligence. AI has the capability of changing our lives as we know it. The question is how to ensure AI benefits society instead of harming us. As a recovering Computer Science major, I know this will not be an easy or quick or one-time task, but I believe Congress has an essential role to play in the future of AI. I have been heartened to see so many Members of Congress of all political persuasions agree,” said Co-Chair Ted Lieu (CA-36). “I am honored to join Congressman Jay Obernolte in leading this Task Force on AI, and honored to work with the bipartisan Members on the Task Force. I look forward to engaging with Members of both the Democratic Caucus and Republican Conference, as well as the Senate, to find meaningful, bipartisan solutions with regards to AI.”
Rep. Ted Lieu (CA-36), Co-Chair Rep. Anna Eshoo (CA-16) Rep. Yvette Clarke (NY-09) Rep. Bill Foster (IL-11) Rep. Suzanne Bonamici (OR-01) Rep. Ami Bera (CA-06) Rep. Don Beyer (VA-08) Rep. Alexandria Ocasio-Cortez (NY-14) Rep. Haley Stevens (MI-11) Rep. Sara Jacobs (CA-51) Rep. Valerie Foushee (NC-04) Rep. Brittany Pettersen (CO-07)
Rep. Jay Obernolte (CA-23), Chair Rep. Darrell Issa (CA-48) Rep. French Hill (AR-02) Rep. Michael Cloud (TX-27) Rep. Neal Dunn (FL-02) Rep. Ben Cline (VA-06) Rep. Kat Cammack (FL-03) Rep. Scott Franklin (FL-18) Rep. Michelle Steel (CA-45) Rep. Eric Burlison (MO-07) Rep. Laurel Lee (FL-15) Rep. Rich McCormick (GA-06)
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FACT SHEET: Presidential Memorandum Establishing the White House Task Force to Address Online Harassment and Abuse
Today, President Biden will sign a Presidential Memorandum establishing the White House Task Force to Address Online Harassment and Abuse, responding to the need for government leadership to address online harms, which disproportionately affect women, girls, people of color, and LGBTQI+ individuals. Vice President Harris will launch the Task Force by hosting a survivor and expert roundtable this afternoon. The tragic events in Buffalo and Uvalde have underscored a fact known all too well by many Americans: the internet can fuel hate, misogyny, and abuse with spillover effects that threaten our communities and safety offline.
President Biden has long championed efforts to prevent and address gender-based violence, including writing and passing the landmark Violence Against Women Act (VAWA) nearly three decades ago as a U.S. Senator and signing its reauthorization into law earlier this year. The reauthorized VAWA includes historic new protections against online harassment and abuse. Vice President Harris, who is hosting today’s Task Force, has long been a champion of addressing online harassment and abuse throughout her career, including as United States Senator and California’s Attorney General.
The Task Force will produce recommendations for the Federal government, state governments, technology platforms, schools, and other public and private entities to prevent and address technology-facilitated gender-based violence, including a focus on the nexus between online misogyny and radicalization to violence. Recommendations will focus particularly on: increasing support for survivors of online harassment and abuse; expanding research to better understand the impact and scope of the problem; enhancing prevention, including prevention focused on youth; and strengthening accountability for offenders and platforms. The Task Force will be co-chaired by the Gender Policy Council and the National Security Council, and will include the Attorney General, the Secretary of Health and Human Services and other heads of Federal agencies.
Strengthening the Federal Response to Online Harms: White House Task Force to Address Online Harassment and Abuse
The Task Force is an interagency effort to address online harassment and abuse, specifically focused on technology-facilitated gender-based violence. In consultation with survivors, advocates, educators, experts from diverse fields, and the private sector, the Task Force will develop specific recommendations to improve prevention, response, and protection efforts through programs and policies in the United States and globally by:
- Improving coordination among executive departments, agencies, and offices to maximize the Federal Government’s effectiveness in preventing and addressing technology-facilitated gender-based violence in the United States and globally, including by developing policy solutions to enhance accountability for those who perpetrate online harms;
- Enhancing and expanding data collection and research across the Federal Government to measure the costs, prevalence, exposure to, and impact of technology-facilitated gender-based violence, including by studying the mental health effects of harassment and abuse perpetrated through social media, particularly affecting adolescents;
- Increasing access to survivor-centered services, information, and support for victims, and increasing training and technical assistance for Federal, State, Tribal, local, and territorial governments, as well as for global organizations and entities in the fields of criminal justice, health and mental health services, education, and victim services;
- Developing programs and policies to address the disproportionate impact of online harassment, abuse, and disinformation campaigns targeting women and LGBTQI+ individuals who are public and political figures, government and civic leaders, activists, and journalists in the United States and globally;
- Examining existing Federal laws, regulations, and policies to evaluate the adequacy of the current legal framework to address technology-facilitated gender-based violence and provide recommendations for strengthening it; and
- Identifying additional opportunities to improve efforts to prevent and address technology-facilitated gender-based violence in United States foreign policy and foreign assistance, including through the Global Partnership for Action on Gender-Based Online Harassment and Abuse.
Background When President Biden first wrote and championed the Violence Against Women Act (VAWA) in the early 1990s, the internet was still in its infancy. Today, the internet has transformed our ability to connect, communicate, and access services and support. At the same time, social media and other forms of technology are increasingly misused as tools of abuse, harassment, and exploitation.
In the United States, one in three women under the age of 35 report being sexually harassed online, and over half of LGBTQI+ individuals report being the target of severe online abuse. Individuals may also be disproportionately targeted because of their race, gender and gender identity, ethnicity, religion, age, disability, sexual orientation, or at the intersection of various identities. Online harassment and abuse take many forms, including the non-consensual distribution of intimate digital images; cyberstalking; sextortion; doxing; malicious deep fakes; gendered disinformation; rape and death threats; the distribution of child sexual abuse materials; online recruitment and exploitation of victims of sex trafficking, including youth; and various other forms of technology-facilitated intimate partner abuse.
Technology-facilitated gender-based violence can have serious consequences, ranging from psychological distress and negative health impacts, including self-harm and suicide, to self-censorship and disruptions to education and economic loss. It can also lead to physical and sexual violence, including homicide. In the United States and around the world, women and LGBTQI+ political leaders, public figures, activists, and journalists face virulent and often sexualized online harassment and abuse, which can undermine human rights and full participation in democracy, governance, and civic life.
Recent mass shootings have also underscored the connections between online harassment, hate, misogyny, and extremist acts. For example, the Uvalde shooter had a history of threatening girls online, yet these violent, sexualized harms and threats were dismissed and ignored when reported. In their annual report on Mass Attacks in Public Spaces , the U.S. Secret Service notes that special focus should be given to assessing threats and preventing violence related to “men who use digital platforms to voice misogynistic views and general animosity toward women.”
The Biden-Harris Administration Efforts to Combat Online Harassment and Abuse
President Biden and Vice President Harris have long been committed to standing with survivors of gender-based violence wherever it occurs—including online. Through this Task Force, they will lead a strategic vision for countering online forms of violence, harassment and abuse. Alongside the launch of the Task Force, the Biden-Harris Administration is undertaking several key actions, including:
- Advancing Technology to Assist Victims of Crime Program. The Department of Justice (DOJ) Office for Victims of Crime will award $3 million to victim services organizations through the Advancing the Use of Technology to Assist Victims of Crime program. This program will support initiatives that use technology to increase access to services and information about victims’ rights, enhance service providers’ understanding of technology-facilitated gender-based violence, and strengthen the responsiveness of victim service organizations supporting survivors of technology-facilitated gender-based violence.
- National Domestic Violence Hotline Survivor Survey . The National Domestic Violence Hotline, through funding from the U.S. Department of Health and Human Services, Family Violence Prevention and Services Program, will provide a preliminary report on its survivor survey research project, which was undertaken this spring and for the first-time asked survivors about their experiences of online harassment and abuse. The Hotline heard from approximately 1,000 survivors who completed the survey. Every survivor reported they had experienced at least one form of online harassment or abuse, including 45% who said they experienced cyberstalking, 27% reported being threatened with the posting of intimate images without permission; 17% reported the posting of intimate pictures without permission; and 12% reported sextortion. These insights will help inform the work of the Task Force.
- Research from the National Threat Assessment Center . The U.S. Secret Service’s National Threat Assessment Center (NTAC), under the Department of Homeland Security, is adding to its research on the nexus between online misogyny and domestic terrorism by preparing a report examining the role of domestic violence as a motive and precursor to mass violence, including an analysis of the prior communications and online presence of the attackers. This report will build on its most recent report, Hot Yoga Tallahassee: A Case Study of Misogynistic Extremism , which analyzes the background of a 2018 attacker who killed two women and injured four more at a yoga studio in Tallahassee, FL, and highlights the specific threat posed by misogynistic extremism.
- Research on Access to Services for Survivors of Cyberstalking . The Department of Justice Office on Violence Against Women has funded the National Opinion Research Center to collect nationally representative data on cyberstalking in the United States to assess its scope and nature, as well as determine survivors’ access to services and any unmet needs. Research is underway, and report findings will be published later this year.
- Expanded Focus on Technological Abuse in the Reauthorized Violence Against Women Act. The Department of Justice (DOJ) will implement new statutory provisions in the recent reauthorization of the Violence Against Women Act (VAWA) of 2022, which includes for the first time a definition of “technological abuse,” recognizing the importance of addressing this form of abuse at the intersection with domestic violence, sexual assault, stalking, and dating violence. Under VAWA 2022, the Attorney General will develop a national strategy to prevent and address cybercrimes against individuals, including cyberstalking and the non-consensual distribution of intimate images of adults, and directs the FBI to improve data collection regarding these crimes. DOJ will also help raise awareness among victim advocates of the new VAWA provision that establishes a federal civil cause of action for an individual who has an intimate visual depiction of themselves disclosed without their consent, with damages up to $150,000 and attorney’s fees.
- New Report on the Online Harassment of Women Political Figures. In partnership with the State Department’s Office of Global Women’s Issues, Texas A&M University’s Program on Women, Peace, and Security are releasing a report on “Technological Threats: How Online Harassment of Female Political Figures Undermines Democracy.” The report highlights research and policy on the intersection between online harassment, technology, women’s political participation, and democracy.
- Expansion of the Global Partnership for Action on Gender-Based Online Harassment and Abuse. To address online harassment and abuse globally, the State Department will expand the Global Partnership for Action on Gender-Based Online Harassment and Abuse, announced at the Summit for Democracy in December and officially launched in March at the United Nations Commission on the Status of Women. The Global Partnership brings together countries, international organizations, civil society, and the private sector to better prioritize, understand, prevent, and address the growing scourge of technology-facilitated gender-based violence around the world. Since its launch, the Global Partnership has continued to grow its member countries, and recently welcomed the governments of Canada, Chile, and New Zealand, who joined the United States, along with Australia, Denmark, the Republic of Korea, Sweden, and the United Kingdom.
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Sustainability Task Force seeking community ideas
Whether it’s proposals for making campuses more efficient or pitches for eco-friendly community engagement, a new task force is eager to hear ideas from the university community as it charts the course for WSU’s sustainability efforts in the years to come.
The WSU Sustainability Task Force was formed as part of a broader effort to ensure the university is at the forefront of environmentally-conscious efforts in higher education. Some 50 members of the university community, including faculty, staff and students from across the system, are split into four subcommittees focused on specific areas:
- Research, innovation, and creativity
- Student experience
- Outreach, extension, service, and engagement
- Institutional effectiveness, and infrastructure
Subcommittee members from each area are currently putting together goal proposals for wider consideration by the task force’s executive committee. The executive committee is led by Julie Padowski, a research associate professor in the School of the Environment and co-director for the Center for Environmental Research, Education and Outreach , and Jason Sampson, director of Environmental Health and Safety .
“This is the first task force I’ve been involved with where we had more volunteers than we could bring onto the committees,” Sampson said. “Because of that enthusiasm, we knew we needed to come up with a way for individuals to bring their ideas forward and ensure as many perspectives from across the university system were heard and considered.”
Ideas on making WSU more sustainable can be submitted through March 7 via the redesigned sustainability website .
Building a more sustainable future
In the months ahead, the subcommittees will offer their draft goals to the task force’s executive committee, which will then coalesce those pitches into a proposal for considering by the WSU Board of Regents. Regents are expected to vote on adopting core goals for sustainability in September.
“As a task force, we’re thinking about short term measurable goals and outcomes that we can start tracking immediately to gauge the success of our current sustainability efforts, as well as looking further down the road at targets that are more ambitious,” Padowski said.
While surveying the higher education landscape on sustainability plans, Sampson noted that many are focused on how to make their campuses more environmentally friendly. While that’s something WSU is doing as well, it’s important for land grant institutions to engage with community across the state on ways universities can help them be more sustainable. It’s also vital to explore opportunities to further research into the conservation of natural resources and give students the tools and expertise necessary to make an impact on environmental initiatives after they graduate.
WSU’s refreshed Sustainability website includes information on several ongoing efforts, from efficiencies in operations to the significant number of research projects and centers dedicated to ensuring the long-term health of the planet.
The university has identified four key areas of focus within its sustainability efforts:
- Reduce emissions across the WSU System throughout all dimensions of operations by both direct reductions of greenhouse gas emissions and indirect actions to reduce goods, services, and activities that contribute to carbon pollution.
- Discover, promote, and invest in regenerative practices that conserve and rebuild natural resources and sustain ecosystem services, via research, academic programs, and extension/outreach.
- Build a working culture of sustainability across the WSU system by engaging with our diverse partners in tribal, extension, and other statewide efforts.
- Engage with other land-grant institutions to rapidly share and disseminate ideas and explore collective actions that promote the reduction of emissions and adopt regenerative practices.
WSU program helps first‑gen graduate student pursue science to help community
Teachers’ growth mindset appears more important than warmth
WSU students take award at national construction management competition
Alumni to share their stories during WSU’s National TRIO Day Celebration
Water Research Center spring seminar series
WSU veterinary chaplain one of a few in the nation
Public comments and nominations, about the uspstf.
- Recommendation Topics
- Recommendation: Lung Cancer: Screening
Final Recommendation Statement
Lung cancer: screening, march 09, 2021.
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation .
- View the Clinician Summary in PDF
- Supporting Evidence and Research Taxonomy
- Related Resources & Tools
- Final Evidence Review (March 09, 2021)
- Modeling Study (March 09, 2021)
- Final Modeling Report (March 09, 2021)
- Evidence Summary (March 09, 2021)
- Final Research Plan (August 16, 2018)
- Screening for Lung Cancer: AFP's Putting Prevention Into Practice - Educational Tools
- Lung Cancer Screening (PDQ)--Health Professional Version - For Providers
- "How to Quit Smoking" Patient Resources
- JAMA Patient Page: Screening for Lung Cancer
- JAMA Podcast: Screening for Lung Cancer
- Lung Cancer Screening (PDQ)--Patient Version
- Smoking Cessation: Fast Facts
- Tips From Former Smokers
Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228,820 persons were diagnosed with lung cancer, and 135,720 persons died of the disease. 1
The most important risk factor for lung cancer is smoking. 2 , 3 Smoking is estimated to account for about 90% of all lung cancer cases, 2 with a relative risk of lung cancer approximately 20-fold higher in smokers than in nonsmokers. 3 Increasing age is also a risk factor for lung cancer. The median age of diagnosis of lung cancer is 70 years. 4 , 5
Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. 1 However, early-stage lung cancer has a better prognosis and is more amenable to treatment.
The US Preventive Services Task Force (USPSTF) concludes with moderate certainty that annual screening for lung cancer with LDCT has a moderate net benefit in persons at high risk of lung cancer based on age, total cumulative exposure to tobacco smoke, and years since quitting smoking. The moderate net benefit of screening depends on limiting screening to persons at high risk, the accuracy of image interpretation being similar to or better than that found in clinical trials, and the resolution of most false-positive results with serial imaging rather than invasive procedures.
Refer to the Table for more information on the USPSTF recommendation rationale and assessment. For more details on the methods the USPSTF uses to determine the net benefit, see the USPSTF Procedure Manual. 6
Patient Population Under Consideration
This recommendation applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
Assessment of Risk
Smoking and older age are the 2 most important risk factors for lung cancer. 3-5 The risk of lung cancer in persons who smoke increases with cumulative quantity and duration of smoking and with age but decreases with increasing time since quitting for persons who formerly smoked. 3 The USPSTF considers adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years to be at high risk and recommends screening for lung cancer with annual LDCT in this population.
African American/Black (Black) men have a higher incidence of lung cancer than White men, and Black women have a lower incidence than White women. 1 These differences are likely related to differences in smoking exposure (ie, prevalence of smoking) and related exposure to carcinogens in cigarettes. 7 , 8 The differences may also be related to other social risk factors.
Other risk factors for lung cancer include environmental exposures, prior radiation therapy, other (noncancer) lung diseases, and family history. Lower level of education is also associated with a higher risk of lung cancer. 7 The USPSTF recommends using age and smoking history to determine screening eligibility rather than more elaborate risk prediction models because there is insufficient evidence to assess whether risk prediction model–based screening would improve outcomes relative to using the risk factors of age and smoking history for broad implementation in primary care.
Low-dose computed tomography has high sensitivity and reasonable specificity for the detection of lung cancer, with demonstrated benefit in screening persons at high risk. 9-11 Other potential screening modalities that are not recommended because they have not been found to be beneficial include sputum cytology, chest radiography, and measurement of biomarker levels. 12 , 13
The 2 lung cancer screening trials that showed a benefit of lung cancer screening used different screening intervals. The National Lung Screening Trial (NLST) screened annually for 3 years. 9 The Nederlands-Leuvens Longkanker Screenings Onderzoek (NELSON) trial screened at intervals of 1 year, then 2 years, then 2.5 years. 11 Modeling studies from the Cancer Intervention and Surveillance Modeling Network (CISNET) 14 , 15 suggest that annual screening for lung cancer leads to greater benefit than does biennial screening. Based on the available evidence and these models, the USPSTF recommends annual screening.
Treatment and Interventions
Lung cancer can be treated with surgery, chemotherapy, radiation therapy, targeted therapies, immunotherapy, or combinations of these treatments. 16 Surgical resection is generally considered the current treatment of choice for patients with stage I or II non–small cell lung cancer (NSCLC). 17
Implementation of Lung Cancer Screening
Available data indicate that uptake of lung cancer screening is low. One recent study using data for 10 states found that 14.4% of persons eligible for lung cancer screening (based on 2013 USPSTF criteria) had been screened in the prior 12 months. 18 Increasing lung cancer screening discussions and offering screening to eligible persons who express a preference for it is a key step to realizing the potential benefit of lung cancer screening.
Screening Eligibility, Screening Intervals, and Starting and Stopping Ages
As noted above, the USPSTF recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have at least a 20 pack-year smoking history. Screening should be discontinued once a person has not smoked for 15 years.
The NLST 9 and the NELSON trial 11 enrolled generally healthy persons, so those study findings may not accurately reflect the balance of benefits and harms in persons with comorbid conditions. The USPSTF recommends discontinuing screening if a person develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
Smoking Cessation Counseling
All persons enrolled in a screening program who are current smokers should receive smoking cessation interventions. To be consistent with the USPSTF recommendation on counseling and interventions to prevent tobacco use and tobacco-caused disease, 19 persons referred for lung cancer screening through primary care should receive these interventions concurrent with referral. Because many persons may enter screening through pathways besides referral from primary care, the USPSTF encourages incorporating such interventions into all screening programs.
Shared decision-making is important when clinicians and patients discuss screening for lung cancer. The benefit of screening varies with risk because persons at higher risk are more likely to benefit. Screening does not prevent most lung cancer deaths; thus, smoking cessation remains essential. Lung cancer screening has the potential to cause harm, including false-positive results and incidental findings that can lead to subsequent testing and treatment, including the anxiety of living with a lung lesion that may be cancer. Overdiagnosis of lung cancer and the risks of radiation exposure are harms, although their exact magnitude is uncertain. The decision to undertake screening should involve a thorough discussion of the potential benefits, limitations, and harms of screening.
Standardization of LDCT Screening and Follow-up of Abnormal Findings
The randomized clinical trials (RCTs) that provide evidence for the benefit of screening for lung cancer with LDCT were primarily conducted in academic centers with expertise in the performance and interpretation of LDCT and the management of lung lesions seen on LDCT. Clinical settings that have similar experience and expertise are more likely to duplicate the beneficial results found in trials.
In an effort to minimize the uncertainty and variation about the evaluation and management of lung nodules and to standardize the reporting of LDCT screening results, the American College of Radiology developed the Lung Imaging Reporting and Data System (Lung-RADS) classification system and endorses its use in lung cancer screening. 20 Lung-RADS provides guidance to clinicians on which findings are suspicious for cancer and the suggested management of lung nodules detected on LDCT. Data suggest that the use of Lung-RADS may decrease the rate of false-positive results in lung cancer screening. 21
Additional Tools and Resources
The Centers for Disease Control and Prevention has several websites with many resources to help patients stop smoking:
- “How to Quit” resources ( https://www.cdc.gov/quit )
- Smoking Cessation: Fast Facts ( https://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/smoking-cessation-fast-facts/ )
- Tips From Former Smokers ( https://www.cdc.gov/tobacco/campaign/tips/ )
The National Cancer Institute has developed resources to help patients stop smoking ( https://www.smokefree.gov ). It has also developed patient and clinician guides on screening for lung cancer:
- Lung Cancer Screening (PDQ)–Patient Version ( https://www.cancer.gov/types/lung/patient/lung-screening-pdq )
- Lung Cancer Screening (PDQ)–Health Professional Version ( https://www.cancer.gov/types/lung/hp/lung-screening-pdq )
Other Related USPSTF Recommendations
Prevention of initiation of smoking and smoking cessation for those who smoke are the most important interventions to prevent lung cancer. The USPSTF has made recommendations on interventions to prevent the initiation of tobacco use in children and adolescents 22 and on the use of pharmacotherapy and counseling for tobacco cessation. 19
This recommendation replaces the 2013 USPSTF recommendation on screening for lung cancer. In 2013 the USPSTF recommended annual screening for lung cancer with LDCT in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years (abbreviated as A-55-80-30-15). 23 For this updated recommendation, the USPSTF has changed the age range and pack-year eligibility criteria and recommends annual screening for lung cancer with LDCT in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years (A-50-80-20-15). Abbreviations for screening recommendations are expanded in the Box .
As in the 2013 recommendation, the USPSTF recommends that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.
Scope of Review
To update its 2013 recommendation, the USPSTF commissioned a systematic review 24 , 25 on the accuracy of screening for lung cancer with LDCT and the benefits and harms of screening for lung cancer. The review also assessed whether the benefits of screening vary by subgroup (eg, by race or sex) or by the number or frequency of LDCT scans and whether the harms associated with screening and the evaluation of lung nodules differ with the use of Lung-RADS, International Early Lung Cancer Action Program (I-ELCAP), or similar approaches (eg, to reduce false-positive results). In addition, the review assessed whether the use of risk prediction models for identifying adults at higher risk of lung cancer mortality improves the balance of benefits and harms of screening compared with the use of trial eligibility criteria or variants of the prior USPSTF recommendation criteria.
In addition to the systematic evidence review, the USPSTF commissioned collaborative modeling studies from CISNET 14 , 15 to provide information about the optimal age at which to begin and end screening, the optimal screening interval, and the relative benefits and harms of different screening strategies, including risk factor–based strategies using age, pack-year smoking history, and years since quitting smoking for former smokers, compared with modified versions of multivariate risk prediction models. The modeling studies complement the evidence that the systematic review provides.
Accuracy of Screening Tests
The USPSTF reviewed several RCTs and cohort studies that reported on the sensitivity, specificity, or predictive value of LDCT, using eventual diagnosis of lung cancer as the reference standard. 24 , 25 Not all of the reviewed studies reported all test accuracy data. In the studies that reported it, sensitivity ranged from 59% to 100%, specificity ranged from 26.4% to 99.7%, positive predictive value ranged from 3.3% to 43.5%, and negative predictive value ranged from 97.7% to 100%.
In the NLST 26 and NELSON trial, 11 the reported sensitivities were 93.1% and 59%, respectively, and reported specificities were 76.5% and 95.8%, respectively. Although the negative predictive values were similar for the NLST and NELSON trial (99.9% and 97.7%, respectively), the positive predictive values were very different (3.3% and 43.5%, respectively). This discrepancy is largely accounted for by the trials’ differing definitions of a positive finding and screening protocols—the NELSON trial used a volumetric approach and added an indeterminate nodule result category (ie, an indeterminate finding was not considered a positive result even if it led to additional testing). The NLST used an approach of maximum diameter without an indeterminate category (ie, any nodule meeting the diameter criteria was considered a positive result).
Three retrospective studies compared how various approaches for nodule classification would alter the accuracy of LDCT. 21 , 27 , 28 The first study demonstrated that using Lung-RADS in the NLST would have increased specificity while decreasing sensitivity. 21 The other 2 studies found that use of I-ELCAP criteria (increase in nodule size threshold to an average diameter of 5 mm, 6 mm, or larger) would increase positive predictive value. 27 , 28
Benefits of Early Detection and Treatment
The USPSTF reviewed 7 RCTs that evaluated lung cancer screening with LDCT. 24 , 25 The NLST 9 and the NELSON trial 11 were the only trials adequately powered to detect a lung cancer mortality benefit.
The NLST, the largest RCT to date (n = 53,454), enrolled participants aged 55 to 74 years at the time of randomization who had a tobacco use history of at least 30 pack-years and were current smokers or had quit within the past 15 years. The mean pack-year smoking history in NLST participants was 56 pack-years. 9 The NELSON trial (n = 15,792) enrolled participants aged 50 to 74 years who had a tobacco use history of at least 15 cigarettes a day (three-fourths of a pack per day) for more than 25 years or 10 cigarettes a day (one-half of a pack per day) for more than 30 years and were current smokers or had quit within the past 10 years. The median pack-year smoking history in NELSON trial participants was 38 pack-years. 11
The NLST reported a relative risk reduction in lung cancer mortality of 20% (95% CI, 6.8%-26.7%)9; a subsequent analysis of NLST data with additional follow-up and end point verification reported a relative risk reduction of 16% (95% CI, 5%-25%). 10 At 10 years of follow-up, the NELSON trial reported 181 lung cancer deaths among participants in the screening group and 242 in the control group (incidence rate ratio [IRR], 0.75 [95% CI, 0.61-0.90]). 11 , 24 The NLST also found a reduction in all-cause mortality with LDCT screening compared with chest radiography (IRR, 0.93 [95% CI, 0.88-0.99]). Results of the other trials were imprecise, without any statistically significant differences between screening with LDCT and chest radiography or no screening. 24
Evidence on screening interval comes from the NLST and the NELSON trial and CISNET modeling studies. The NLST screened annually for 3 years. 9 The NELSON trial screened at intervals of 1 year, then 2 years, then 2.5 years. 11 The CISNET modeling studies suggest that annual screening with LDCT provides greater benefit in decreasing lung cancer mortality and in life-years gained compared with biennial screening. 14
Several lines of evidence suggest that screening for lung cancer in persons with fewer pack-years of smoking (ie, fewer than the 30 pack-year eligibility criterion of the 2013 USPSTF recommendation) and at an earlier age can increase the benefits of screening. As noted, the NELSON trial enrolled persons aged 50 to 74 years (about one-fourth of participants were younger than 55 years) who had accumulated fewer pack-years of smoking (half of a pack per day for more than 30 years or three-fourths of a pack per day for more than 25 years). 11 This trial provides empirical evidence for the benefit of screening for lung cancer with LDCT in persons aged 50 to 55 years and with lighter pack-year smoking histories.
The CISNET modeling studies also provided data that helped inform the pack-year eligibility criterion for lung cancer screening and the ages at which to start and stop screening. The USPSTF focused on screening programs in the 1960 birth cohort (more representative of current smoking patterns compared with earlier cohorts) that yielded lung cancer mortality reductions at least as great as the 2013 USPSTF screening program (A-55-80-30-15). For screening programs that provide this level of mortality benefit and also maximize, or come close to maximizing, both lung cancer deaths averted and life-years gained for any given level of LDCT screening, in at least 3 of the 4 CISNET models (ie, “consensus-efficient” programs), the majority (52%) have a minimum pack-year eligibility criterion of 20 pack-years. Almost all have a starting age of 50 or 55 years, and all have a stopping age of 80 years. 14 , 15
Relative to the 2013 USPSTF screening program (A-55-80-30-15), CISNET modeling analyses suggest that annually screening persons aged 50 to 80 years who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years (A-50-80-20-15) would be associated with lung cancer mortality reduced by 13.0% vs 9.8%, with avoiding 503 vs 381 lung cancer deaths, and with 6918 life-years gained vs 4882 life-years gained per 100,000 persons in the population aged 45 to 90 years over a lifetime of screening. 14 Thus, this screening program would be associated with important reductions in lung cancer deaths and increases in life-years gained compared with the previous recommendation and is supported by new trial data and the CISNET modeling studies.
Screening for lung cancer in persons at an earlier age and with fewer pack-years of smoking (ie, 20 pack-years) may also help partially ameliorate racial disparities in screening eligibility. Data suggest that Black persons who smoke have a higher risk of lung cancer than do White persons, and this risk difference is more apparent at lower levels of smoking intensity. 7 One recent analysis of Southern Community Cohort Study participants found that 17% of Black persons who smoke were eligible for lung cancer screening based on the 2013 USPSTF eligibility criteria compared with 31% of White persons who smoke. In the same study, among persons diagnosed with lung cancer, a significantly lower percentage of Black persons who smoke (32%) were eligible for screening than were White persons (56%). 29 Data also suggest that Latinx/Hispanic persons who smoke accumulate fewer pack-years than White persons who smoke. 30 , 31 A strategy of annually screening persons aged 50 to 80 years who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years (A-50-80-20-15) would increase the relative percentage of persons eligible for screening by 87% overall—78% in non-Hispanic White adults, 107% in non-Hispanic Black adults, and 112% in Hispanic adults compared with 2013 USPSTF criteria (A-55-80-30-15). 14 Similarly, a strategy of screening persons aged 50 to 80 years who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years (A-50-80-20-15) would increase the relative percentage of persons eligible for screening by 80% in men and by 96% in women, 14 because they accumulate fewer pack-years than men. 32
Simulation studies suggest that risk prediction models to determine eligibility for lung cancer screening could be associated with reduced lung cancer deaths and the number of participants needed to screen to prevent 1 lung cancer death. The CISNET modeling studies commissioned by the USPSTF thus compared the benefits and harms of screening programs based on risk prediction models vs risk factor–based screening (ie, using age and smoking history). The risk prediction models used were modified versions of the PLCOm2012 model, 33 the Lung Cancer Death Risk Assessment Tool (LCDRAT) model, 34 and the Bach model, 35 limited to age, sex (for those models that include sex as a variable, such as the LCDRAT and Bach models), smoking intensity, and smoking duration (and setting other potential variables such as race, education, body mass index, personal history of cancer, or family history of lung cancer to their reference value). Because age is an important risk factor for lung cancer, these risk prediction models shifted screening to persons of older age and increased the number of lung cancer deaths averted, but screening occurs at older ages when there are fewer years to be gained. Thus, some risk prediction model–based screening programs were associated with slightly increased life-years gained, while some were not or were associated with even slightly decreased life-years gained. Risk prediction models also were associated with increased the number of over diagnosed lung cancers, which are more common in older individuals. 14
It is possible that the use of a more complex risk prediction model to determine eligibility might impose a barrier to wider implementation and uptake of lung cancer screening, a service that currently has low uptake. Currently, there are no studies that have prospectively compared the use of USPSTF criteria considering age, pack-year smoking history, and number of years since quitting vs risk prediction models as criteria for lung cancer screening, so it is uncertain whether using a risk prediction model would improve lung cancer detection and clinical outcomes. The International Lung Screening Trial (ILST), a prospective cohort study that is comparing the accuracy of the PLCOm2012 model against the 2013 USPSTF criteria for detecting lung cancer, may provide some evidence regarding this issue. 36 In summary, determining eligibility for lung cancer screening using more complex risk prediction models may represent an implementation barrier, and there is currently insufficient evidence to assess whether risk prediction model–based screening would improve outcomes relative to simply using the risk factors of age and smoking history.
Harms of Screening and Treatment
Harms of screening can include false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, radiation-induced cancer, incidental findings, and increases in distress or anxiety.
The NLST reported false-positive rates of 26.3% for baseline, 27.2% for year 1, and 15.9% for year 2.9 The NELSON trial reported false-positive rates of 19.8% at baseline, 7.1% at year 1, 9.0% for males at year 3, and 3.9% for males at year 5.5 of screening. 11 , 37 An implementation study through the Veterans Health Administration revealed a false-positive rate of 28.9% of veterans eligible for screening (58% of those who were actually screened) at baseline. 38 Both of these studies were conducted prior to the use of the Lung-RADS protocol for nodule classification, the use of which may reduce false-positives, albeit at the cost of some false-negatives. One retrospective study assessed how use of Lung-RADS would have changed the false-positive result rate in the NLST and found a false-positive rate among baseline results for Lung-RADS of 12.8% (95% CI, 12.4%-13.2%) vs 26.6% (95% CI, 26.1%-27.1%) for the NLST approach. 21
The further workup of false-positive results can result in significant harms such as additional imaging, biopsy, or surgical procedures. Fourteen studies reported on the evaluation of false-positive results. Among all patients screened, the percentage who had a needle biopsy for false-positive results ranged from 0.09% to 0.56%. Complication rates from needle biopsy for false-positive results ranged from 0.03% to 0.07% of all patients screened. Surgical procedures for false-positive results were reported in 0.5% to 1.3% of all screened participants. 24
In the NLST, false-positive results led to invasive procedures (needle biopsy, thoracotomy, thoracoscopy, mediastinoscopy, and bronchoscopy) in 1.7% of patients screened. Complications occurred in 0.1% of patients screened, and death in the 60 days following the most invasive procedure performed to evaluate a false-positive result occurred in 0.007% of those screened. 9 One study estimated that the use of Lung-RADS criteria would have prevented 23.4% of invasive procedures due to false-positive results. 21
In the CISNET modeling studies, the false-positive rate varied based on screening eligibility criteria. Relative to the 2013 USPSTF criteria (A-55-80-30-15), the 2021 USPSTF criteria (A-50-80-20-15) would result in 2.2 vs 1.9 false-positive results per person over a lifetime of screening. 14 Note that screening programs that start at younger ages or use a lower pack-year eligibility screen a larger total number of persons.
Determining the rate of overdiagnosis in screening trials is challenging because the duration of follow-up affects the calculation of excess, potentially over diagnosed, cancers in the screening vs control groups. Initially, the NLST reported 119 additional lung cancers (1060 total cancers with LDCT vs 941 with chest radiography) after 3 screening rounds and 6.5 years of follow-up (IRR, 1.12 [95% CI, 1.02-1.22]). 9 , 24 With extended follow-up, the NLST found no statistically significant difference between groups for overall lung cancer incidence; however, this study had some methodological limitations, including use of a different ascertainment method during posttrial follow-up, lack of information on any posttrial screening that may have occurred in either the LDCT or chest radiography group, and missing data. 39 In the NELSON trial, 40 excess lung cancers (344 cancers in the LDCT group vs 304 in the control group) were reported in the LDCT group after the a priori planned 10 years of follow-up; after 11 years of follow-up, there was an excess of 14 cancers with LDCT. 11
In the CISNET modeling studies, which account for lifetime follow-up, the 2013 USPSTF screening program (A-55-80-30-15) would result in 6.3% of screen-detected cases of lung cancer being over diagnosed lung cancers vs 6.0% lung cancers being overdiagnoses with the 2021 screening program (A-50-80-20-15). 14
In the 9 publications reporting on radiation exposure associated with LDCT, 24 the radiation exposure associated with 1 LDCT scan ranged from 0.65 to 2.36 mSv. For context, average annual background radiation exposure in the US is 2.4 mSv. Two of the studies estimated the cumulative radiation exposure for participants undergoing screening with LDCT. Using estimated radiation exposure from screening and follow-up evaluations and estimates of the risk of radiation-induced cancer deaths, the Italian Lung Cancer Screening Trial (ITALUNG) estimated a lifetime risk of fatal cancer of 0.11 cases per 1000 persons for LDCT after the 4 screening rounds, 40 and the Continuing Observation of Smoking Subjects study estimated a lifetime risk of 2.6 to 8.1 major cancers per 10,000 persons screened after 10 rounds of annual screening. 41
The CISNET modeling studies found that lifetime estimates of radiation-related lung cancer deaths varied by eligibility criteria for screening. Relative to the 2013 USPSTF recommendation (A-55-80-30-15), the 2021 USPSTF recommendation (A-50-80-20-15) would be associated with an estimated 38.6 vs 20.6 radiation-related lung cancer deaths per 100 000 persons in the total population aged 45 to 90 years, or 1 death caused for every 13.0 vs 18.5 lung cancer deaths avoided by screening. 14
When comparing LDCT groups vs control groups for smoking cessation or abstinence outcomes, evidence does not indicate that screening leads to lower rates of smoking cessation or continued abstinence or to higher rates of relapse. Several studies suggest that, compared with no screening, individuals who receive LDCT screening do not have worse health-related quality of life, anxiety, or distress over 2 years of follow-up. However, screening participants who receive true-positive or indeterminate results may experience worse health-related quality of life, anxiety, or distress in the short-term. 24
Studies reported a wide range of screening-related incidental findings that were deemed significant or required further evaluation (4.4% to 40.7%), in part because of inconsistent definitions of what constitutes an incidental finding and which findings were clinically significant. 24 Older age was associated with a greater likelihood of incidental findings. Common incidental findings included coronary artery calcification, aortic aneurysms, emphysema, and infectious and inflammatory processes. Other common findings were masses, nodules, or cysts of the kidney, breast, adrenal gland, liver, thyroid, pancreas, spine, and lymph nodes. Cancers involving the kidney, thyroid, or liver were ultimately diagnosed in 0.39% of NLST participants in the LDCT group during screening. 42
Incidental findings led to downstream evaluation, including consultations, additional imaging, and invasive procedures with associated costs and burdens. The benefits of incidental detection of nonlung cancer conditions and the balance of benefits and harms of incidental findings on LDCT screening remain uncertain.
Response to Public Comment
A draft version of this recommendation statement was posted for public comment on the USPSTF website from July 7, 2020, to August 3, 2020. Most comments generally agreed with the draft recommendation, although some requested broadening the eligibility criteria for lung cancer screening and others mentioned that additional risk factors for lung cancer other than smoking exist or that lung cancer can occur in persons who never smoked. In response, the USPSTF acknowledges that there are risk factors for lung cancer other than smoking; however, current evidence does not support the incorporation of these risk factors as determinants of eligibility for lung cancer screening. The USPSTF also acknowledges that lung cancer can occur in persons who never smoked or among persons who currently smoke or formerly smoked who do not meet screening eligibility criteria. Nevertheless, smoking is the major risk factor for lung cancer, all trials of screening for lung cancer have been conducted among persons who smoke or were former smokers, and trial and modeling data support the current USPSTF recommendation as offering a reasonable balance of benefits and harms.
Some comments suggested the use of more complex risk prediction models to determine eligibility for lung cancer screening. In response, the USPSTF clarified language that use of these risk prediction models might make implementation more difficult, and that there are currently no lung cancer screening trials prospectively comparing USPSTF eligibility criteria with risk prediction models. The USPSTF also added a reference to the ILST, a prospective cohort study addressing this issue.
In response to comments, the USPSTF also added information about the currently low uptake of lung cancer screening and data on the effect of the current recommendation on eligibility for screening in Latinx/Hispanic persons. Last, the USPSTF added and updated resources and website links in the Additional Tools and Resources section.
How Does the Evidence Fit With Biological Understanding?
Lung cancer is a proliferation of malignant cells that originate in lung tissue. Smoking is the strongest risk factor for lung cancer. Older age is also associated with increasing incidence of lung cancer. Lung cancer is classified into 2 major categories based on cell type and immunohistochemical and molecular characteristics: NSCLC, which collectively comprises adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, and small cell lung cancer. Screening is aimed at early detection of NSCLC rather than small cell lung cancer because the latter is much less common and typically spreads too quickly to be reliably detected at an early, potentially curable stage by screening.
Currently, 79% of patients present with lung cancer that has spread to regional lymph nodes or metastasized to distant sites. Only 17% of patients present with localized disease. Patients with localized disease have a 59% 5-year survival rate, compared with 32% for those with regional spread and 6% for those with distant metastases. 1 By leading to earlier detection and treatment, screening for lung cancer can give patients a greater chance for cure.
- Implementation research addressing how best to increase the uptake of lung cancer screening discussions in clinical practice is needed, particularly among the populations at higher risk of death from lung cancer or populations that are socially and economically disadvantaged.
- Research is needed to evaluate whether, as lung cancer screening is implemented in more diverse community settings, including among racial/ethnic minorities, among populations socially and economically disadvantaged (for whom smoking prevalence and lung cancer incidence is higher), and in settings that screen greater numbers of women, the balance of benefits and harms differs from those observed in RCTs.
- Research to identify biomarkers that can accurately identify persons at high risk is needed to improve detection and minimize false-positive results.
- Research to identify technologies that can help more accurately discriminate between benign and malignant lung nodules is needed.
- Research is needed on the benefits and harms of using risk prediction models to select patients for lung cancer screening, including whether use of risk prediction models represents a barrier to wider implementation of lung cancer screening in primary care.
The American Association for Thoracic Surgery recommends annual lung cancer screening with LDCT for North Americans aged 55 to 79 years with a 30 pack-year history of smoking. It also recommends offering annual lung cancer screening with LDCT starting at age 50 years to persons with a 20 pack-year smoking history if there is an additional cumulative risk of developing lung cancer of 5% or greater over the following 5 years. 43
The American Cancer Society recommends annual lung cancer screening with LDCT for persons aged 55 to 74 years who are in fairly good health, have at least a 30 pack-year smoking history, and currently smoke or have quit within the past 15 years. It also recommends smoking cessation counseling for current smokers, shared decision-making about lung cancer screening, and that screening be conducted in a high-volume, high-quality lung cancer screening and treatment center. 44
The American College of Chest Physicians suggests that annual screening with LDCT should be offered to asymptomatic smokers and former smokers aged 55 to 77 years who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years. It also recommends that screening not be performed for individuals with comorbidities that adversely influence their ability to tolerate the evaluation of screen-detected findings or tolerate treatment of an early-stage screen-detected lung cancer or that substantially limit their life expectancy. 45
The National Comprehensive Cancer Network recommends annual screening for lung cancer with LDCT in persons aged 55 to 77 years who have at least a 30 pack-year smoking history and currently smoke or have quit within the past 15 years or in persons 50 years or older who have at least a 20 pack-year smoking history and have at least 1 additional risk factor for lung cancer. 46
The American Academy of Family Physicians has concluded that the evidence is insufficient to recommend for or against screening for lung cancer with LDCT in persons at high risk of lung cancer based on age and smoking history. 47
The US Preventive Services Task Force members include the following individuals: Alex H. Krist, MD, MPH (Fairfax Family Practice Residency, Fairfax, Virginia, and Virginia Commonwealth University, Richmond); Karina W. Davidson, PhD, MASc (Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York); Carol M. Mangione, MD, MSPH (University of California, Los Angeles); Michael J. Barry, MD (Harvard Medical School, Boston, Massachusetts); Michael Cabana, MD, MA, MPH (University of California, San Francisco); Aaron B. Caughey, MD, PhD (Oregon Health & Science University, Portland); Esa M. Davis, MD, MPH (University of Pittsburgh, Pittsburgh); Katrina E. Donahue, MD, MPH (University of North Carolina at Chapel Hill); Chyke A. Doubeni, MD, MPH (Mayo Clinic, Rochester, MN); Martha Kubik, PhD, RN (George Mason University, Fairfax, Virginia); C. Seth Landefeld, MD (University of Alabama, Birmingham); Li Li, MD, PhD, MPH (University of Virginia, Charlottesville); Gbenga Ogedegbe, MD, MPH (New York University, New York, New York); Douglas K. Owens, MD, MS (Stanford University, Stanford); Lori Pbert, PhD (University of Massachusetts Medical School, Worcester); Michael Silverstein, MD, MPH (Boston University, Boston, Massachusetts); James Stevermer, MD, MSPH (University of Missouri, Columbia); Chien-Wen Tseng, MD, MPH, MSEE (University of Hawaii, Honolulu); John B. Wong, MD (Tufts University School of Medicine, Boston, Massachusetts).
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures . All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. Dr Barry reported receiving grants and personal fees from Healthwise.
Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.
Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an evidence-based practice center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.
Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.
Additional Information: The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.
Copyright Notice: USPSTF recommendations are based on a rigorous review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs. To encourage widespread discussion, consideration, adoption, and implementation of USPSTF recommendations, AHRQ permits members of the public to reproduce, redistribute, publicly display, and incorporate USPSTF work into other materials provided that it is reproduced without any changes to the work of portions thereof, except as permitted as fair use under the US Copyright Act.
AHRQ and the US Department of Health and Human Services cannot endorse, or appear to endorse, derivative or excerpted materials, and they cannot be held liable for the content or use of adapted products that are incorporated on other Web sites. Any adaptations of these electronic documents and resources must include a disclaimer to this effect. Advertising or implied endorsement for any commercial products or services is strictly prohibited.
This work may not be reproduced, reprinted, or redistributed for a fee, nor may the work be sold for profit or incorporated into a profit-making venture without the express written permission of AHRQ. This work is subject to the restrictions of Section 1140 of the Social Security Act, 42 U.S.C. §320b-10. When parts of a recommendation statement are used or quoted, the USPSTF Web page should be cited as the source.
Abbreviations: LDCT, low-dose computed tomography; USPSTF, US Preventive Services Task Force.
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