Lung Cancer Screening

Monday, August 1^st was World Lung Cancer Day, which reminded me that we haven't talked about the latest lung cancer screening guidelines.  Lung cancer is the leading cause of cancer deaths in the U.S, for both women and men, accounting for approximately 22% of cancer deaths.  I lost my father to lung cancer almost 30 years ago.  I certainly wish there had been a screening test for lung cancer back then.  Unfortunately, many people don't realize that there is a screening test for lung cancer available now.  Let's talk more about this.

How important is lung cancer screening?

In 2020, an estimated 228,820 people were diagnosed with lung cancer, and 135,720 people died from this cancer.

The most important risk factor for lung cancer is smoking.  Smoking is estimated to account for about 90% of all lung cancer cases.  The relative risk for lung cancer is approximately 20 times higher in smokers than in nonsmokers.  The risk for lung cancer also increases with age. 

Lung cancer in general has a poor prognosis, with an overall 5-year survival rate of 20.5%.  However, early-stage lung cancer responds to treatment much better, resulting in a better prognosis for improvement when the disease is diagnosed early.

Who should have lung cancer screening?

The 2021 guidelines from the U.S. Preventive Services Task Force (USPSTF) recommend lung cancer screening for people who meet these three criteria:

• People between age 50 and 80
• With a 20 pack-year smoking history
• Who are either current smokers, or have quit within the last 15 years

What exactly is a pack-year?

Take the number of packs of cigarettes smoked per day and multiply by how many years you smoked that much.  For instance, if you smoke 2 packs per day for 10 years (2x10=20), you have smoked 20 pack-years.  If you smoked 2 packs per day for 5 years, then cut down to 1 pack per day for the last 10 years, you have smoked 20 pack-years.

What test is recommended for lung cancer screening? How often should testing be done?

For people who meet the criteria, the USPSTF recommends yearly screening for lung cancer with low dose computed tomography (LD CT scan). This test has high sensitivity for detecting lung cancer, with a reasonable specificity. It also provides a lower dose of radiation than a traditional CT scan.

How effective is lung cancer screening?

Research shows that low dose CT screening among those at high risk for lung cancer reduces the lung cancer death rate by up to 20%.

Lung cancer screening is also highly cost effective.  Offering tobacco cessation interventions in combination with screening significantly increases the cost-effectiveness.

When should screening for lung cancer stop?

Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

How are we currently doing with lung cancer screening?

Research indicates that only about 5 to 15% of Americans who are candidates for screening, are actually getting the screening done.  We need to improve this number!

What can you do?

If you meet the criteria for lung cancer screening, talk with your doctor about the test and consider having it done.

If you know someone who might meet the criteria, encourage them to talk with their doctor about screening.

Encourage your local community to publicize cancer screening guidelines.

If you have any questions about lung cancer screening, please log into your account and send us your question. We are here to help. Dr. Anita Bennett MD - Health Tip Content Editor