Who should be screened for lung cancer now?

Who should be screened for lung cancer now?

New lung cancer screening guidelines will allow more than 5 million additional U.S. adults to be screened for lung cancer. People between the ages of 50 and 80 who smoke or have previously smoked more than 20 packs per year are entitled to a preventive examination. Experts recommend speaking to your doctor about your smoking history and your eligibility for an exam.

Are you a candidate for lung cancer screening?

Earlier this week, the American Cancer Society (ACS) released updated lung cancer screening guidelines that will allow more than 5 million more U.S. adults who smoke and have smoked to be screened for lung cancer.

“With new data from the NELSON trial published in 2020, we now had additional evidence that lung cancer screening was effective in people who start screening at age 50 (compared to 55) and have a lower smoking history,” said Robert A. Smith, PhD, senior vice president for cancer screening at ACS and director of the ACS Center for Cancer Screening.

"This recommendation increased the number of people who have ever smoked by 32%, from about 8.1 million to 14.3 million," he said.

The NELSON study mentioned by Smith showed that lung cancer mortality among former and current smokers can be reduced through the use of low-dose CT scanners, particularly if the disease is detected early.

Here's what you need to know about the new guidelines and what impact they may have.

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How the new guidelines have changed

Before this new policy, the ACS recommended regular lung cancer screenings for people ages 55 to 74 who smoked at least 30 packs per year.

This screening recommendation was aimed at people who currently smoke and those who quit smoking less than 15 years ago. Under the new guidelines, it doesn't matter when a person stopped smoking - it is still recommended to get checked for lung cancer.

“The evidence we have collected shows that in people who have previously smoked, the risk of lung cancer continues to increase [rise] with age,” Smith said.

He explained that eliminating the “years since quitting” criterion is expected to prevent 21% more lung cancer deaths and provide more years of life for those who adhere to screening guidelines.

Smith said there are three key changes to the guidelines. These include:

Expansion of the age range for lung cancer screening to 50 to 80 years (from 55 to 74 years previously). Reduction of the pack-year history for lung cancer screening to 20+ pack-years (from previously 30+ pack-years). Elimination of standard years since quitting due to lung cancer cancer screening (it used to be up to 15 years since I quit smoking)

How to prevent lung cancer

How the updated guidelines will impact diagnosis

The goal of these new guidelines is to reduce the number of people who die from lung cancer - especially since this type of cancer is the leading cause of cancer death in the United States

With the new guidelines, cancer experts hope to change this trend, especially since lung cancer survival depends on how early it is detected.

Screening is crucial because it can potentially diagnose lung cancer at the earliest possible stageBeforePatients ever develop symptoms, said Michael Wert, MD, director of the James Lung Cancer Screening Clinic at Ohio State Wexner Medical CenterHealth.

He explained that most lung cancers are diagnosed as soon as a patient shows symptoms, which usually means the cancer is already advanced and less amenable to curative measures such as surgery.

“It is absolutely proven that lung cancer screening saves lives,” he said.

In addition to early diagnosis, early screening also improves outcomes.

Royce Calhoun, MD, medical director of thoracic surgery at St. Elizabeth Healthcare in Edgewood, Kentucky, explained The reason lung cancer is so deadly is that typically more than 70% of cases are discovered in late stages and are difficult to cure.

“In this population of patients with advanced disease, the overall survival rate is about 10%,” he said. "If lung cancer is caught early, in stages I and II, it is very curable. This is particularly true for stage I - [which is] a tumor the size of a marble in the lung that has not spread. [It] has cure rates of more than 70%."

How many lives will be saved?

Typically, screening detects early-stage cancers, while later-stage cancers are detected when people have symptoms, Dr. Daniel Boffa, division chief of thoracic surgery and clinical director of the Center for Breast Cancer at Yale Cancer Center and Smilow Cancer HospitalHealth.

“Screening works by detecting dangerous cancers before they do dangerous things,” he said. “Overall, people who participate in lung cancer screening reduce their risk of dying from lung cancer by 20%.”

In fact, according to Boffa, for every 300 people who undergo lung cancer screening, one patient's life is saved.

“The problem is that over 90% of those eligible do not attend lung cancer screening,” he said. “If even half of eligible people started participating, it is estimated that 20,000 lives would be saved each year in the United States.”

Who is not eligible for screening?

According to Smith, the ACS does not recommend screening for adults under age 50 or with a smoking history of less than 20 packs.

“We also do not recommend lung cancer screening in those with life-limiting comorbidities or an expected life expectancy of less than five years,” he said.

Additionally, people who have never smoked are not recommended for screening, although one in seven lung cancers occurs in a person who has never smoked, Boffa explained.

“It is still a rare phenomenon,” he said, “and it would not make sense at this point to screen every person who has never smoked for lung cancer.”

However, certain groups of people have a higher risk of developing lung cancer, even than non-smokers.

“It wouldn't surprise me if screening guidelines changed in the coming years to include people who have a first-degree relative with lung cancer and who have never smoked,” Boffa said.

What young and middle-aged women need to know about lung cancer

Why it is important to get checked

Lung cancer screening with low-dose noncontrast chest CT is a highly effective and proven screening tool for lung cancer. It is also by far the best way to detect lung cancer early, when there are no symptoms and the disease is curable, Calhoun said.

“Lung cancer can exist in the lungs, grow and sometimes spread locally, possibly for years, without causing any symptoms,” he explained. “By the time a patient experiences symptoms, the cancer has often already spread and the patient’s chances of recovery are slim.”

If you are over 50 and currently smoke or have previously smoked, talk to your doctor about potentially life-saving lung cancer screening.

Calhoun pointed out that people who have had a lot of secondhand smoke, chemical fumes, exhaust fumes, poor air quality, high radon levels, or a family history of lung cancer (for people who have never smoked) should also talk to their doctor about getting a lung cancer screening.

“If lung cancer screenings were performed on all eligible patients in the United States,” he said, “it would save tens of thousands of lives each year by detecting as many of these cancers early when they are curable.”

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