Who Currently Needs to Undergo Lung Cancer Screening?

Are you qualified for lung cancer screening?

This week, the American Cancer Society (ACS) has issued revised lung cancer screening guidelines. These updated rules will enable an additional 5 million adults from the U.S., both current and former smokers, to be screened for lung cancer.

"After acquiring new data from the 2020 NELSON trial, more evidence is available demonstrating that lung cancer screening is effective for people who begin screening at the age of 50, as opposed to 55, and those with lighter smoking histories," stated Robert A. Smith, the ACS's senior vice president of cancer screening and the ACS Center for Cancer Screening's director.

Smith added, "This suggestion has enlarged the group of former smokers by 32%, escalating from roughly 8.1 million individuals to 14.3 million."

Smith highlighted the NELSON trial which proved that using low-dose CT scanners could lower lung cancer mortality rates amongst current and former smokers, particularly if the disease is detected in the early stages.

Here's what you need to know about these new guidelines and the people it may affect.

Prior to these newly introduced guidelines, the ACS advised regular lung cancer screenings for people aged between 55 to 74, who have a smoking history equivalent to at least a 30-pack per year.

This recommendation was intended for current smokers and those who have quit smoking less than 15 years ago. Under the new regulations, irrespective of when a person quit smoking—they are still encouraged to undergo a lung cancer screening.

"The evidence collected indicates that amongst former smokers, the risk of lung cancer continues to elevate with their increasing age," Smith noted.

Smith conveyed that removing the "years since quit" requirement predicts a 21% reduction in lung cancer fatalities and adds extra years to the lifespan of those adhering to the new screening guidelines.

Smith outlined three major changes in the amended guidelines:

The primary aim of these revised guidelines is to lower the deaths caused by lung cancer, especially considering such a cancer type is the leading cause of cancer death in the U.S.

The updated guidelines aim to alter this course, particularly considering lung cancer survival rates are influenced by the stage at which it is detected.

Screening is crucial as it can identify lung cancers at the earliest possible stages before symptoms appear, shared Michael Wert, MD, director of the James Lung Cancer Screening Clinic at The Ohio State Wexner Medical Center.

Wert pointed out that most lung cancers are diagnosed when symptoms have already surfaced indicating an advanced stage where curative measures prove difficult such as surgery.

"Lung cancer screening undeniably saves lives," he asserted.

Early diagnosis through early screening also enhances treatment results.

Royce Calhoun, MD, St. Elizabeth Healthcare's medical director of thoracic surgery in Edgewood Kentucky, stated that the significant mortality rate of lung cancer is due to the fact that more than 70% of cases are discovered at late stages making them challenging to treat.

"In patients with advanced disease, the overall survival rate is roughly 10%," he noted. "However, if lung cancer is detected early, specifically in stages I and II, it is considerably curable. A stage I tumor, similar in size to a small marble in the lung that hasn't metastasized, has cure rates over 70%."

Typically, early-stage cancers are discovered during screening, while late-stage cancers are detected when people start exhibiting symptoms, explained Daniel Boffa, MD, Yale Cancer Center's thoracic surgery division chief and clinical director of the Center for Thoracic Cancers.

Boffa emphasized, "Screening identifies dangerous cancers before they inflict harm. Participating in lung cancer screening reduces lung cancer fatality rates by 20%."

According to Boffa, for every 300 people who undergo lung cancer screening, one life can be saved.

"The issue lies in the fact that over 90% of eligible individuals don't partake in lung cancer screening," Boffa stated. "If half the eligible individuals began to participate, an estimated 20,000 lives could be saved annually in the United States."

Smith specified, the ACS does not advise adults younger than 50 or those with less than a 20-pack year smoking history to undergo screening.

"Screening is also not recommended for individuals with a life-limiting co-morbidity or expected lifespan less than five years," he added.

Furthermore, individuals who have never smoked are not advised to undertake screening, despite one out of seven lung cancers being detected in individuals who have never smoked, Boffa explained.

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

That said, certain groups of people are at higher risk of developing lung cancer, even as non-smokers.

“I would not be surprised if screening guidelines change in the coming years to include people who had a first-degree relative develop lung cancer, who never smoked,” Boffa said.

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

“Lung cancer can exist in the lungs, growing and sometimes spreading locally, potentially for years without causing any symptoms,” he explained. “Often, by the time a patient develops symptoms, the cancer has spread and the chance of curing the patient is low.”

If you are over 50 and you smoke now or smoked previously, talk to your healthcare provider about getting a potentially life-saving lung cancer screen.

Calhoun noted that people who have been around a lot of second-hand smoke, chemical fumes, exhaust, poor air quality, high radon levels, or have a family history of lung cancer in people who never smoked should also talk to their physician about getting a lung cancer screening.

“If lung cancer screenings were applied to all eligible patients in the United States,” he said, “it would save tens of thousands of lives per year by finding so many of these cancers early, when curable.”