Updated guidelines expand lung cancer screening eligibility

Today, the U.S. Preventive Services Task Force (USPSTF) released new guidelines for annual lung cancer screening through low-dose CT scans. The new guidelines nearly double the number of people eligible for lung cancer screening, both by lowering the recommended age range to begin screening from 55 to 50 and reducing the minimum pack-year smoking history from 30 to 20. Pack-year history measures an individual’s exposure to tobacco; it’s defined as the number of packs of cigarettes smoked per day multiplied by the number of years a person has smoked.

Lung cancer is the leading cause of cancer-related deaths worldwide. Most cases are linked to tobacco use. The goal of lung cancer screening is to find cancer early, before symptoms appear, when it’s easier to treat.  

Screening more women and Black adults

Experts expect the lower age and pack-year history requirements will help improve lung cancer early detection in two key demographic groups: women and Black adults.

“Women and African-Americans are two demographic groups that are more likely to develop lung cancer after less cumulative exposure to tobacco,” says Mara Antonoff, M.D. “The new lung cancer screening guidelines could help us identify cancer earlier in these high-risk groups.”

Lung cancer screening should be done every year

The guidelines recommend annual screening. This means that in order for lung cancer screening to be fully beneficial, eligible individuals need to be screened every year. Unfortunately, only 14% of current and former smokers who were eligible for lung cancer screening under the previous guidelines have been screened.  

“We need to do a better job of getting screening services to people,” says Robert Volk, Ph.D. “It’s important for individuals to not only get their first lung cancer screening but to stay current and get it done every year.”

Volk led a study that found only 55% of people who received lung cancer screening outside of a clinical trial kept up with the annual recommendation. The study, published in JAMA Network Open in November, found that those with well-known health disparities, including current smokers, minorities and those without a college degree were less likely to be up to date with lung cancer screening recommendations.

“It really highlights the important challenge of ensuring people are screened annually,” Volk says. “We need to go beyond focusing on strategies to get people in for their initial screening, and focus on interventions to help primary care providers make sure people get screened every year.”

Quitting smoking is still the most important way to reduce lung cancer risk

While lung cancer screening plays an important role in reducing lung cancer deaths, the most important action anyone can take to avoid lung cancer is to quit – or never start – smoking or using other tobacco products.

“Although smoking rates are lower than ever before, tobacco use and exposure is, sadly, still the leading cause of cancer and preventable deaths,” says Ernest Hawk, M.D. “We know that the most effective approach for tobacco cessation is through a combination of medication and counseling. That’s why we encourage current smokers to reach out to their doctor or state quitline for assistance or participate in a tobacco cessation research study. These studies allow us to develop new innovations that may help tobacco users even more successfully in the future.” 

MD Anderson recently launched a 100% digital tobacco cessation study that’s open to current smokers living anywhere in Texas. Participants receive 12-weeks of virtual counseling and medicine, an approach that has been effective in MD Anderson’s Tobacco Treatment Program for patients and employees. If you live outside of Texas and want help to quit smoking, call 800-QUIT-NOW (800-784-8669) or visit smokefree.gov to be connected to your state’s quitline.

Why people without a smoking history aren’t screened for lung cancer

Although lung cancer is primarily caused by smoking, 20% of lung cancer patients have never smoked and aren’t eligible for lung cancer screening.

Lung cancer screening is reserved for people who smoke because the screening process carries its own risks. “We don’t screen non-smokers because in a very low-risk population, there is a greater chance of doing more harm than good,” Volk says.

The guidelines also recommend patients meet with their providers prior to screening to ensure they understand the potential harms and benefits associated with screening.    

Whether you have a history of smoking or not, Antonoff recommends talking to your doctor if you experience any of the following symptoms: a cough that doesn’t go away, pneumonia that isn’t cleared up by antibiotics, unexpected weight loss or voice changes.

“If you have a symptom that doesn’t seem right, get it checked out,” she says. “It may not be lung cancer, but it’s important to advocate for yourself and find out if there is a serious health problem that needs treatment.” 

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