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• Posted November 2, 2023

Experts Widen Criteria for Those Who Should Get Lung Cancer Screening

The American Cancer Society has expanded its recommendations for who should get lung cancer screening.

The updated guidance now says annual screening should start at a younger age and among those who smoke less, and it should continue regardless of how many years ago a former smoker may have quit.

"If you are a person who formerly smoked, once 15 years had elapsed since your cessation you were no longer eligible for lung cancer screening on the assumption that your risk had just gotten too low over time to justify screening," explained Robert Smith, senior vice president for Early Cancer Detection Science at the American Cancer Society (ACS).

"When we look at that, actually the continuing absolute risk and people who had a significant number of years of smoking, we found that just wasn't true," Smith said. "In fact, your risk declined a little bit after you stopped smoking. Then it flattened out and started increasing again as your age increased, and eventually, rising pretty steeply -- about 9% a year if you smoked 20 cigarettes a day."

To address that, screening should now start at age 50 and continue until age 80, the ACS said. In addition, those who have smoked at least 20 cigarettes a day for 20 years or more should be screened; the previous recommendation was 20 cigarettes a day for 30 years.

The report was published Nov. 1 in the journal CA: A Cancer Journal for Clinicians.

These recommendations are now in line with those of the U.S. Preventive Services Task Force, which were issued two years ago, Smith said. The only difference is the recommendation that screening starts regardless of how long ago someone quit smoking. That's not part of the task force recommendation, so these people may find that their screening is not covered by their insurance company, he said.

"Also, a lot of people who are eligible for lung cancer screening don't have health insurance," Smith said.

"People who are eligible tend to be more likely to be lower-income, they aren't well-integrated into health care," he noted. "Many people who still smoke or formerly smoked have not been treated very well by health care systems. There's a lot of stigma associated with smoking and there's certainly a lot of stigma associated with lung cancer as a disease caused by smoking."

But lung cancer screening does save lives, one expert stated.

"For people who smoke, lung cancer screening with low-dose CT scans has been shown to reduce deaths due to lung cancer," said Dr. Don Dizon, a professor of medicine at Brown University and co-author of an editorial accompanying the report.

"Still, the best strategy to reduce the risk of lung cancer is to prevent it by not smoking, and if one does smoke, to stop," Dizon said.

While stopping smoking will lower one's risk of lung cancer compared with those who continue to smoke, they still face an elevated risk of lung cancer. For this reason, they should discuss the option to participate in lung cancer screening programs with their doctor, he said.

"Removing the years since one quit as a criterion for screening will increase the proportions of people eligible for screening," Dizon said. "It's estimated that it will do this by 30% across white, Hispanic and Asian groups, and by 27% among Black individuals."

Increasing lung cancer screening remains important across the United States, where only 18% to 30% of all who are eligible are screened, Dizon noted.

Dr. Brett Bade, a pulmonologist at Northwell Health in New York City, said that lung cancer screening catches the disease early and new treatments can now save lives.

With screening, up to 50% of lung cancers are found early whereas before screening only 20% were identified, he said.

"We have the potential to find up to half or more of lung cancers in an early stage if we broadly implement lung cancer screening and there are immunologic therapies and targeted therapies that are extending people's lives significantly," Bade said.

More information

For more on lung cancer, see the American Cancer Society

SOURCES: Robert Smith, PhD, senior vice president, Early Cancer Detection Science, American Cancer Society; Don Dizon, MD, professor, medicine, Brown University, Providence, R.I.; Brett Bade, MD, pulmonologist, Northwell Health, New York City; CA: A Cancer Journal for Clinicians, Nov. 1, 2023