Only 5.7% of Americans At High Risk for Lung Cancer Are Screened Annually; Here’s What You Need to Know About This Potentially Lifesaving Procedure

Unlike some other cancer types, lung cancer screening is only recommended for people who are identified as high risk. In March 2021, the United States Preventive Services Task Force expanded its definition of "high risk" to include a broader age range, and to include more current and former smokers.

From 2013 until 2021, people were said to be at high risk of lung cancer (and therefore eligible for screening) if they had smoked a pack or more a day for 30 years or more. In March, the guideline was broadened to include anybody who smoked a pack a day for at least 20 years.

This change significantly expands the amount of women and Black people who are included in the high risk category. The statistics published by the American Lung Association do not reflect these changes, however, because they were collected before the recommendations had been adjusted.

Screening is one of the most important tools we have for fighting lung cancer, as detecting lung cancer early gives doctors the best possible shot at finding a curative treatment. According to the American Lung Association, annual screening with low-dose CT scans can reduce the lung cancer death rate by up to 20%.

Lung cancer screenings have become more evolved and helpful over the years, but not that many people who are eligible for the tests take advantage of them. Dr. Brendon Stiles breaks down how they can be helpful.

Understanding Lung Cancer

Lung cancer is the second most common type of cancer, and it is the leading cause of cancer deaths for men and women in the United States. Diagnosis and treatment of the disease can be challenging since symptoms often don't appear until the cancer has spread. An initial symptom, for example, could be as serious as a seizure if the lung cancer has already spread to the brain. But other symptoms can include increased coughing, chest pain, unexplained weight loss, shortness of breath, wheezing, losing your voice or persistent infections like bronchitis or pneumonia.

The two main types of lung cancer are non-small cell, which makes up 85 percent of cases, and small-cell. These types act differently and, accordingly, require different types of treatment. Dr. Patrick Forde, a thoracic oncologist at Johns Hopkins Medicine, tells SurvivorNet about how distinguishing between the two types and their subtypes can be very beneficial.

"Within that non-small cell category, there's a subtype called non-squamous adenocarcinoma, and that's the group of patients for whom genetic testing is very important on the tumor," he explains. "Genetic testing is looking for mutations in the DNA, in the tumor, which are not present in your normal DNA."

Lung Cancer Screening

More men and women die of lung cancer than of colon, breast and prostate cancers combined, but how can screenings make a difference? Lung cancer usually affects people above the age of 65, but a small number of people are diagnosed younger than 45 years old.

Many lung cancers are found accidentally, but screening can help doctors diagnose lung cancers at earlier stages of the disease when successful treatment is more likely. Early-stage lung cancers that are removed with surgery may even be curable. But more often than not, lung cancer diagnoses come after the disease has already spread to other parts of the body making it more difficult to treat. According to the American Lung Association’s 2021 “State of Lung Cancer” report, only 24% of lung cancer cases are diagnosed at early stages.

"In about 70 to 80 percent of patients who are diagnosed with lung cancer, unfortunately the cancer has spread outside of the lung and is not suitable for surgery," Dr. Forde tells SurvivorNet.

But screening methods such as the low-dose computed tomography (CT) scan can save lives if those who are at risk participate. This test uses a very small amount of radiation to create highly detailed pictures of your lungs to reveal cancer long before initial symptoms.

"The concern is perhaps patients who are on Medicaid or don't have insurance will not be referred for appropriate screening," Dr. Forde says. "I think it behooves us all to try and increase the uptake of CT screening in particular, given that it's been shown to reduce lung cancer mortality."

28-year-old lung cancer survivor Amanda Kouri advocates for early detection, because she wants everyone with the disease to have a story like hers.

Who Should Get Screened?

You should talk to your doctor about getting a low-dose CT scan (LDCT) or chest x-ray if you are at high risk or if you experience a cough that doesn't go away, a cough that produces bloody mucus, or if you experience chest pain or trouble swallowing or breathing.

Nearly 20 percent of people who die from lung cancer in the United States each year have never smoked or used any other form of tobacco, but smoking is a major risk factor for the disease. Tobacco in cigarettes is a carcinogen that causes mutations in lung cells and enables the growth of cancer. If you quit smoking, you can significantly reduce your risk of developing the disease.

In March 2021, the U.S. Preventive Services Task Force (USPST) introduced new guidelines which dropped the age of eligibility for lung cancer screening and the number of "pack years," or number of years a person smoked an average of one pack of cigarettes a day. The new guidelines specify that adults ages 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should be screened. If someone smoked one pack of cigarettes per day for 20 years, their "pack history" would be 20 years, and they should be screened. But if someone smoked two packs a day for 10 years, they would also have a 20 year "pack history."

The USPSTF says that expanding screening eligibility will be "especially helpful" to black people and women and will increase screening access. Data shows that both groups tend to smoke fewer cigarettes than white men. Data also shows that black people have a higher risk of lung cancer than white people.

Contributing: SurvivorNet staff

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