Smoker Anonymous at 4th Street Live on July 24, 2023 in Louisville, KY.
Jahi Chikwendiu | The Washington Post | Getty Images
Only a fraction of people at high risk for lung cancer are screened for the disease, even though it kills more in the United States than breast, colon and prostate cancer combined. The American Cancer Society’s new guidelines will allow millions more to become eligible for regular scans that can detect tumors early enough to save lives.
With one important exception, the new guidelines echo existing recommendations from the highly influential US Preventive Services Task Force. In 2021, the panel said people aged 50 to 80 had smoked at least 20 “pack years” and whether they still smoke or have stopped smoking in the past 15 years should be checked annually with a low-dose computed tomography, a type of X-ray.
Under the new guidance released on Wednesday, even heavy smokers who stopped smoking 15 years ago or more should get the annual tests.
Experts say the previous guidance was based on a flawed assumption: the longer it had been since a person had quit smoking, the lower their cancer risk.
A close look at the data on who had been diagnosed with lung cancer revealed that the risk of cancer increased as people got older, even among those who had stopped smoking for 15 years or more, said Dr. William Dahut, chief scientific officer of American Cancer. Society and one of the authors of the guidelines.
Although the lungs of ex-smokers might have gotten a little better initially, that effect wasn’t permanent, he said.
“People developed a false sense of security,” which may have contributed to the “absolutely low” screening rates, Dahut said.
A 2022 report from the American Lung Association reported that only 5.8% of Americans had been screened for lung cancer and that in some states, rates were as low as 1%.
“Compare that to a mammogram, which about two-thirds of women get when they reach a certain age,” she said.
Under previous guidelines, 14.3 million people in the US would have been eligible for screening. The new constitution will include an additional 5 million people, Dahut said.
The prognosis for people whose cancer is diagnosed late is grim. The overall five-year survival rate for lung cancers diagnosed between 2012 and 2018 was 23 percent, the guideline authors note.
More than 80% of people whose lung cancer was caught early through screening were still alive 20 years later, according to research from the Icahn School of Medicine at Mount Sinai in New York, presented in Radiological Society of North America meeting last year. According to the estimates of the anti-cancer company, this year there will be 238,340 new cases of lung cancer and 127,070 deaths from the disease.
Lung cancer is so deadly because most people are not diagnosed until it is too late. Many smokers and ex-smokers don’t realize that a simple low-dose CT scan can catch lung cancer early enough to save their lives. Even among primary care doctors, who would be the ones ordering the tests, “there is confusion,” Dahut said.
Generally, Medicare and commercial insurance companies pay for tests recommended by the task force. But it may take some time for insurance to cover the extra people included in the new guidelines, Dahut suggested.
Dr. Chi-Fu Jeffrey Yang, a thoracic surgeon at Massachusetts General Hospital in Boston, has been doing informal surveys to get a better idea of why people might not be getting screened.
“We asked people if they had heard of it. Nobody had,” he said. “But everyone had heard of mammograms for breast cancer, colonoscopies for colon cancer and Pap smears for cervical cancer.”
Today’s low screening rates are “a national tragedy,” said Dr. David Yankelewicz, director of the lung biopsy service at the Icahn School of Medicine. “This should be by far our biggest weapon against cancer. That such a small percentage is being examined is quite frightening and a major failure.”
He would like the screening criteria to be broadened even further, especially for women, blacks and Native Americans. Research has shown that these groups are more vulnerable to developing lung cancer either at lower exposures or at a younger age.
“They have a higher risk at younger ages and in shorter pack years,” Yankelevitz said.
The change in screening guidelines to include long-time quitters is “huge,” said Dr. Panagis Galiatsatos, director of the Tobacco Treatment and Cancer Control Clinic at Johns Hopkins Medicine in Baltimore.
“People in their 40s and 50s who smoked two packs of cigarettes a day in their teens and young adulthood often don’t consider themselves smokers,” he said. “But they have to be scanned.”