Who is Currently Recommended for Lung Cancer Screening?

 

Who is Currently Recommended for Lung Cancer Screening?

Are You Eligible for Lung Cancer Screening?

Recently, the American Cancer Society (ACS) updated its lung cancer screening guidelines, potentially expanding screening eligibility for over 5 million additional U.S. adults who smoke or used to smoke. According to Robert A. Smith, PhD, senior vice president of cancer screening at ACS, and director of the ACS Center for Cancer Screening, this update is based on new data from the NELSON trial, published in 2020. The trial demonstrated the effectiveness of lung cancer screening for individuals starting at age 50, particularly those with lighter smoking histories. As a result, the recommendation now extends screening eligibility to a broader group, increasing the number of eligible individuals from approximately 8.1 million to 14.3 million. The NELSON trial findings underscore the potential of low-dose CT scans in reducing lung cancer mortality, especially when the disease is detected early. These updated guidelines have significant implications for who may qualify for lung cancer screening, potentially impacting a larger portion of the population with a history of smoking.

How the New Guidelines Have Changed?

Previously, the American Cancer Society (ACS) recommended regular lung cancer screenings for individuals aged 55 to 74 with a smoking history of at least 30 pack-years. This recommendation applied to both current smokers and those who quit smoking within the past 15 years. However, under the updated guidelines, the timing of smoking cessation no longer affects screening eligibility. Instead, individuals are encouraged to undergo lung cancer screening regardless of when they quit smoking.

Robert A. Smith, PhD, explained that the elimination of the "years since quit" criterion is expected to result in a 21% reduction in lung cancer deaths and improve life expectancy for those following the screening guidelines.

The revised guidelines introduce three primary changes:

1. Expanding the age range for lung cancer screening from 50 to 80 years old (previously 55 to 74).
2. Lowering the pack-year history requirement for lung cancer screening to 20+ pack-years (down from 30+ pack-years).
3. Eliminating the standard years since quitting criterion for lung cancer screening (previously up to 15 years since quitting).
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5. How The Updated Guidelines Will Impact Diagnosis?

   The primary objective of the new guidelines is to decrease the mortality rate associated with lung cancer, particularly considering its status as the leading cause of cancer-related deaths in the U.S.

   These updated guidelines aim to alter this trajectory, given that the prognosis for lung cancer heavily depends on its early detection. Screening plays a crucial role as it has the potential to identify lung cancers at their earliest stages, even before patients exhibit symptoms. According to Michael Wert, MD, from The Ohio State Wexner Medical Center, most lung cancers are diagnosed only after patients have developed symptoms, indicating an advanced stage of the disease that is less responsive to curative treatments like surgery.

   Dr. Wert emphasized that lung cancer screening has been unequivocally shown to save lives. Early detection not only increases the likelihood of successful treatment but also improves overall outcomes.

   Royce Calhoun, MD, of St. Elizabeth Healthcare, highlighted the stark reality that over 70% of lung cancer cases are typically diagnosed at advanced stages, posing significant challenges for successful treatment. However, when lung cancer is detected early, particularly in stages I and II, it becomes highly curable. Dr. Calhoun cited stage I lung cancer, characterized by a small tumor confined to the lung without spreading, as having cure rates exceeding 70%.

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7. How Many Lives Will Be Saved?

   According to Daniel Boffa, MD, from Yale Cancer Center and Smilow Cancer Hospital, lung cancer screening primarily detects early-stage cancers, whereas later-stage cancers are typically identified when individuals present symptoms.

   Dr. Boffa emphasized that screening effectively identifies dangerous cancers before they progress to a more advanced stage. Overall, individuals who participate in lung cancer screening reduce their risk of dying from lung cancer by 20%.

   In fact, Dr. Boffa stated that for every 300 individuals who undergo lung cancer screening, one patient's life will be saved. However, despite the proven efficacy of screening, he highlighted that over 90% of eligible individuals do not participate in lung cancer screening.

   Dr. Boffa emphasized the potential impact of increased participation, noting that if even half of eligible individuals were to undergo screening, an estimated 20,000 lives could be saved annually in the United States.

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Who Is Not Eligible for Screening?

According to Robert A. Smith from the ACS, individuals under the age of 50 and those with less than a 20-pack year history of smoking are not recommended for lung cancer screening. Additionally, individuals with life-limiting co-morbidities or less than five years of expected longevity are not eligible for screening.

Furthermore, Daniel Boffa explained that screening is not recommended for individuals who have never smoked, despite the fact that a small proportion of lung cancers occur in non-smokers. Boffa emphasized that while this phenomenon is rare, certain groups of non-smokers may be at higher risk, such as those with a first-degree relative who developed lung cancer. He suggested that screening guidelines may evolve in the future to include such high-risk non-smoking populations.

Why It’s Important to Get Screened?

According to Royce Calhoun, lung cancer screening using a low dose non-contrast CT of the chest is an incredibly effective tool for detecting lung cancer, particularly in its early stages when it is asymptomatic and potentially curable.

"Lung cancer can develop and grow within the lungs for years without causing any noticeable symptoms," he explained. "By the time symptoms do arise, the cancer may have already spread, reducing the chances of successful treatment."

For individuals over the age of 50 who currently smoke or have a history of smoking, Calhoun emphasized the importance of discussing lung cancer screening with their healthcare provider, as it could be potentially life-saving.

Furthermore, Calhoun advised that individuals who have been exposed to second-hand smoke, chemical fumes, poor air quality, high radon levels, or have a family history of lung cancer should also consider discussing screening with their physician.

He concluded by highlighting the potential impact of widespread lung cancer screening, stating that it has the potential to save tens of thousands of lives each year by detecting cancers early and increasing the chances of successful treatment.

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