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New Lung Cancer Screening Guidelines

Medically reviewed by Kelly Fan, MD, Susan Kerrigan, MD and Marianne Madsen on January 8, 2023

Lung cancer is the second most common cancer diagnosed in the US, but it is the most deadly. In 2020, lung cancer accounted for 12.7% of all new cancer cases–but 22.4% of all cancer deaths. In fact, more people die every year from lung cancer than they do from breast, colon, and prostate cancers combined. The American Cancer Society estimates that there will be 235,760 new cases and 131,880 deaths in 2021. The majority of cases affect people over the age of 65, with the average age for a diagnosis being about 70.


The overall prognosis is horrifying for people living with lung cancer. Between 2010-16, the five-year survival rate from the disease was just 20.5%.


Of all the leading causes of lung cancer, smoking remains the highest, accounting for around 80% of cases.


Screening for Lung Cancer


The importance of screening for any cancer is to catch it before it starts to show symptoms and it has a chance to spread. For lung cancer, this is particularly important as often the symptoms only become obvious once the cancer is relatively advanced.


According to the Centers for Disease Control (CDC), the only recommended screening test for lung cancer is low-dose computed tomography (LDCT). Studies have shown that screened people have between a 15-20% lower chance of dying from cancer than those who aren’t.


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Lung Cancer - Low Dose CT Screening for Lung Cancer

Lung Cancer - Low Dose CT Screening for Lung Cancer

To be eligible for the screening, you have to be between 55 and 80 years old and either currently smoking or have quit within the last 15 years. You also must have a history of heavy smoking equivalent to 30 pack years. A pack year is defined as smoking an average of one pack a day for a year.


Lung cancer screening rates are low. In 2010, just 3.3% of eligible people were screened. This led to The United States Preventive Services Task Force (USPSTF) recommending in 2013 that people with higher risks of developing cancer should have annual screening. Despite this, by 2015, the rate had risen only slightly, to 3.9%.


New Recommended Guidelines


The USPSTF announced in March 2021 that they were updating their recommended guidelines for lung cancer screening. The revision recommends lowering the age of eligibility from 55 to 50 and reducing the pack years from 30 to 20. The USPSTF believes, based on a review of several studies, that screening people with fewer pack years and at a younger age will improve the benefits of screening.


Benefits of Recommendations


The USPSTF also classed the updated advice as a Grade B recommendation. This is important as under the Affordable Care Act, most health policies must cover preventative services, including those with an A or B recommendation from the USPSTF. It should mean that insurers might start covering the screenings without copays, making it easier for many people to get screened.


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Lung Cancer - Who gets lung cancer?

Lung Cancer - Who gets lung cancer?

The USPSTF also pointed out in their news bulletin to accompany the announcement that lowering the number of pack years will almost double the number of people eligible for screening. 


It will also benefit black people and women. Traditionally these two groups smoke fewer cigarettes per year than white men. Additionally, the risk of contracting lung cancer is higher for black people than for white people.


Most medical professionals have welcomed the new recommendations as a step in the right direction. However, several doctors have published articles and editorials expressing their feelings that the measures still do not go far enough. The concern is for those who will still not be eligible for screening, including patients who contract lung cancer through passive smoking or other factors. According to the American Cancer Society, 20% of lung cancer deaths in the US are people who have never smoked in their lives. This fact might need to be addressed to improve the benefits of screening further.


Written by Chaim Ford

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