Most People at Risk for Lung Cancer Never Get Screened: Here’s How to Fix That

She was told she had less than a year to live after she was diagnosed with lung cancer. Rick Nolan is a former congressman from Minnesota. She was a healthy mother of four. Nolan says that she is the last person you would expect to get such a thing.

About 130,000 people are killed by lung cancer in the US every year. Lung cancer has an almost 60 percent five-year survival rate if it is detected early. Late detection lowers that number to 7 percent.

In the U.S., there is a jumbo jet full of people who are dying of lung cancer that could have had early detection. Most people don't get screened for lung cancer. Increasing outreach to at-risk groups can change that.

There are strict guidelines and a low screening rate.

The most recent guidelines from the U.S. Preventive Services Task Force recommend yearly lung cancer screening. Lung cancer mortality was reduced by up to 25% in two randomized controlled trials. To be eligible for screening, a person must be 50 to 80 years old, have a smoking history of at least 20 pack-years, and have quit within the past 15 years. Michael Barry, a primary care physician at Massachusetts General Hospital, is the vice chair of the USPSTF. The number of people who are eligible for lung cancer screening has increased from 8.1 million to 14.5 million due to the updated guidelines.

Douglas Wood, chair of the department of surgery at the University of Washington, thinks the new guidelines are too strict. There is no evidence that once you turn 80, the harms outweigh the benefits, and that's why the maximum age is arbitrary.

The risk from smoking does not follow a strict time cutoff according to Wood. If someone stops smoking and is worried about lung cancer, the only way they can be screened is to start smoking again or lie.

Barry doesn't believe that the USPSTF guidelines could be used to encourage smoking. He says that they looked at other cutoff points for the maximum age and period of smoking cessation in revising the guidelines. The major lung cancer screening trials didn't include patients who quit smoking more than 15 years ago, so the USPSTF followed their lead. Other groups have different rules of evidence than we do. The guidelines are more similar than not.

A lot of people are left out of the eligibility criteria for the USPSTF. 35 percent of patients with lung cancer would not be eligible for screening under the new guidelines according to one estimate. About 66 percent of black women with lung cancer are diagnosed with it. Black Americans, Hispanics and women are less likely to be eligible for lung cancer screening due to their lower smoking rates. According to a 2000 estimate, about half of women who get lung cancer worldwide have never smoked.

The proportion of women, Black people and Hispanic people who are eligible for screening has been increased by the updated guidelines. He emphasizes that the organization cares about equity in screening and that they are always eager for more evidence.

The challenge for screening is that the number of people who get the scans is very low. Only a small percentage of people who met the old guidelines were screened for lung cancer in 2015. Screening rates for colorectal, cervical and breast cancer are much higher.

Jamie Studts is a professor at the University of Colorado Anschutz Medical Campus School of Medicine. Determining lung cancer screening eligibility can be hard for primary care providers, unlike other cancer screenings that have simple age-based criteria. The stigma and fatalism associated with lung cancer may be related to the gap.

A lack of awareness among physicians and the public may be the main barrier to lung cancer screening. Lung cancer screening was only recommended nine years ago, but other cancer screenings have been around for decades. It may take some time to make the scans part of the culture.

Increasing awareness and access.

The patient advocates and researchers want to speed up the process. A 60-year-old retired public defender from California knows how important they are. She saw a billboard that said lung cancer screening could save her life. Lee brought it up with her doctor, but was told she didn't qualify. After using an online quiz to find out that she was eligible, Lee went to her doctor and was diagnosed with Stage IB lung cancer. She said that a billboard saved her life.

Studts says that awareness campaigns don't need to be fancy but should be more tailored. He works with a network of community partners to educate them about lung cancer screening guidelines and address their concerns. The importance of combining smoking cessation and lung cancer screening discussions is highlighted by Studts. There is an opportunity to use this combination in nationalquit smoking ads. Studts believes that antitobacco campaigns have helped increase lung cancer stigma.

There is a possibility of a collaboration between lung cancer screening and other screening programs. Prosper works on the Mammosphere project to assess eligibility for lung cancer screening among women who already receive mammograms. opportunistic screening is a method in which the high adherence rates of one kind of test are employed in service of another.

The director of the West Virginia University Cancer Institute launched a lung cancer screening unit out of a tractor trailer last year. In order to provide lung cancer screening to those in the most rural parts of the state regardless of insurance status, this 18-wheeler follows in the footsteps of WVU's mobile mammography unit Bonnie's Bus. Local providers evaluate patients for screening eligibility before LUcas arrives. Patients are referred for follow-up care after the scans are read at WVU. In order to bring health care to people, we have to be more inventive.

It is expanding eligibility.

Expanding testing criteria is one way to facilitate screening. She has led an initiative to open lung cancer screening to anyone over the age of 40, regardless of smoking history. One quarter of people diagnosed with lung cancer are never smokers, despite the fact that more people will be found with lung cancer if they have a smoking history. These patients are important to Henschke and he doesn't want to deny them. Nolan wants lung cancer screening to be covered for people who are 40 or older. The Lung Cancer Early Detection and Survival Act of 2020 was named after his daughter. A revised version of the bill was introduced in Congress last year.

The act would change the guidelines of the USPSTF. Nolan says that it would open access to individuals who do not meet the age criteria but are still at high risk of lung cancer because of family history or other risk factors unrelated to smoking. Extending the screening criteria is appropriate if it is part of a clinical trial. He is careful about making this expansion a law. It is still uncommon for patients that have never smoked to have lung cancer. There is a tradeoff between benefits and harms.

There are risks and benefits.

False-positive results can lead to anxiety and additional testing, as well as the overdiagnosis and treatment of small lung nodules that would never have become life threatening. The risk of cancer is increased by the radiation exposure from the scans. Prosper understands the need to talk to patients about these considerations. She says that the radiation risk is low with the LDCT scans and that false-positive rates are decreasing. In the National Lung Screening Trial, the baseline rate was 22 percent and the follow-up rate was 27 percent, but with the Lung-RADS, the rate was 5 to 13 percent.

Overdiagnosis is a serious problem in breast cancer. She doesn't think you could overscreen for lung cancer because we're so underscreening.

The stakes in lung cancer screening are enormous. Lung cancer screening is the most important missed opportunity to change cancer outcomes, according to Studts. Most experts agree that the 5 percent screening rate is not acceptable.

Nolan told her that he was looking forward to being with her. She said no until she got her bill passed. Nolan is working on his daughter's dying wish to help save hundreds of thousands of people from lung cancer in the U.S.