Lung Cancer Screening Expanded To Save More Lives
Lung cancer is by far the No. 1 cause of U.S. cancer deaths, killing more Americans each year than breast and colorectal cancer combined. One important reason? Compared with these other types, it’s detected much later.
The good news is that screening with a low-radiation type of CT scan can catch lung cancer much earlier, when it often can be cured. And now many more people are eligible to be screened.
In March, the U.S. Preventive Services Task Force said that screening should be offered to people ages 50 to 80 who have at least 20 “pack-years” of smoking. For example, those eligible would include someone who had smoked a pack a day for 20 years or two packs a day for 10 years. The screening is offered to current smokers and those who quit within the last 15 years.
Under U.S. law, the task force’s recommendation means that insurance plans have to begin covering screening for those who fit the expanded criteria by next March.
“Historically we never had a good tool to prevent lung cancer,” says Sadia Benzaquen, MD, Chair of Pulmonary, Critical Care and Sleep Medicine for the Einstein Healthcare Network. “Being able to screen people is the most important advance we’ve had.”
Christopher Drumm, MD, of Norristown Family Physicians, agrees. Dr. Drumm says he began sending eligible patients for screening in 2013, when the low-dose CT scan was first recommended.
Finding lung cancer early
“Before that, unless someone was sick, we were finding lung cancer randomly,” he says. “Maybe you had pneumonia or worsening shortness of breath, which then would lead to a chest x-ray that would lead to a CT scan.”
The full-dose CT scan could detect lung cancer, he notes, “but by then it was often in later stages,” when cancer has spread and is much more difficult to treat.
Even now, in the U.S., about 56% of lung cancers are not found until the cancer has spread to distant lymph nodes, organs or both. The five-year relative survival rate for people diagnosed at this stage is only 6%.
Only 18% of lung cancers are found in early stages, when the disease has not spread beyond the lungs or nearby lymph nodes. Survival rates for these early cancers are nearly 60%.
Screening means that far more people have their lung cancer detected when it’s curable. About 64% to 85% of cancers found by screening with low-dose CT scan are in early stages.
The new guidelines, published in March, double the number of people who are eligible for screening. Under the old criteria, the tests started at age 55 and covered people with 30 pack-years of smoking.
Screening benefits for Blacks and women
This expansion especially should benefit women and African Americans, Benzaquen says. On average, “they smoke a little bit less [than white men,] but still develop lung cancer. And this is an important change for Einstein because a large percentage of our population is African American.”
Unfortunately, even among those who had been eligible before the expansion, very few people are getting the low-dose CT screening, which is done annually. Only an estimated 5% to 12% of eligible people have been getting screened.
Nobody is sure why that’s happening, but Dr. Benzaquen and Dr. Drumm have a few theories.
“I think it’s a matter of education, of the patient and the physicians,” Dr. Benzaquen says. “And the other thing is access to care. We need education in the community, in social media, to explain what screening is and why it’s important.”
Dr. Drumm agrees that getting the message out is crucial. “The key is making sure smokers know that we can find lung cancer earlier and that earlier stages can be treated and we can really reduce mortality.”
Dr. Benzaquen also thinks it would help to make screening easier to obtain. He says Einstein Medical Center Philadelphia soon will set up a centralized process administered by a nurse navigator. Einstein Medical Center Montgomery has had a nurse navigator for some time who helps to coordinate lung cancer screening among participating medical practices.
Overcoming stigma, answering questions
A strong recommendation from a doctor might increase screening. Dr. Drumm estimated that about half of the patients he talks to about getting screened actually do so.
First he offers treatments to help people quit smoking. For those who don’t smoke, he always asks if they ever did and how long it’s been since they quit. An ex-smoker’s risk of getting lung cancer doesn’t go down to normal right away. That’s why people who quit up to 15 years ago are eligible for screening.
The stigma and guilt feelings attached to smoking also might discourage people from getting screened, Dr. Drumm says. “You can’t turn a corner without seeing a race or a bracelet for breast cancer screening, but because lung cancer is thought to be self-inflicted, I think it gets left out a little.
“I want to make sure people know that, even though smoking is bad for your health, we still can treat you and we still want to find lung cancer early.”
People do have legitimate questions about whether lung cancer screening is right for them, he notes. Some people worry about radiation. He points out that the dose is low – about one-fifth that of a regular CT scan of the chest. And there’s no contrast medium used, so allergies are not a factor.
Still, the screening isn’t perfect. The vast majority of tests find nothing or find something that’s not cancer, which can lead to more tests. And yet Dr. Drumm strongly recommends it to patients who qualify.
“Advanced lung cancer is really, really bad,” he says, “so applying these guidelines could save a lot of lives.”