Lung cancer is the second most common type of cancer in the world and the leading cause of cancer deaths. More than 80% of these cases are attributed to smoking cigarettes. This means that most cases of lung cancer are preventable. Lung cancer screening guidelines were developed to decrease mortality and improve survival rates with early detection. Here, we’ll discuss what you need to know about current lung cancer screening guidelines and the benefits of early detection.
Lung Cancer Facts and Risk Factors
According to the World Health Organization (WHO), lung cancer was responsible for 2.21 million deaths in 2020. It’s estimated that there will be 238,340 new cases of lung cancer in the United States before the end of 2023. Most cases of lung cancer can be attributed to tobacco use.
When it comes to smoking cigarettes, risk is measured by the amount of tobacco used. This means that people who smoke more and for longer would be considered high risk for developing lung cancer. One way to measure this risk is by pack years. The term “pack years” refers to the number of cigarette packs a person smokes per day multiplied by how many years they have smoked. Let’s say someone has smoked 1 pack a day for 30 years. This means they have 30 pack-years.
While smoking poses the highest lung cancer risk, there are other risk factors, including air pollution and other environmental exposure, and a family history of lung cancer.
Evidence Shows Lung Cancer Screening Guidelines Save Lives
The United States Preventive Services Task Force (USPSTF) gathers evidence on the accuracy of lung cancer screening along with balancing the benefits and risks of screening. The USPSTF did a systematic review of a study called the National Lung Screening Trial. Based on eligibility criteria, including age and tobacco use, this study showed that low-dose computed tomography (LDCT) accurately diagnoses lung cancer. It also showed that early detection led to a significant decrease in mortality compared to chest X-ray.
In other words, depending on a person’s tobacco smoking history, an annual LDCT scan could potentially detect lung cancer in its early stages, which may improve survival rate and life expectancy.
The Role of Low-Dose Computed Tomography Scans
A low-dose computed tomography scan, or LDCT, is an imaging test that is a series of X-ray images or slices that can provide a lot of information about the area of the body being imaged. A major benefit of low-dose CT is that it exposes a person to considerably less radiation compared to a regular-dose CT scan.
A regular-dose CT scan of the chest exposes a person to 7 millisieverts (mSv) while a low-dose CT scan of the chest exposes a person to only 1.5 mSv of radiation. To put this in perspective, the average environmental radiation exposure in the United States is about 3 mSv per year.
What Are the Current Lung Cancer Screening Guidelines?
According to the U.S. Preventive Services Task Force, American Cancer Society (ACS), American Academy of Family Physicians (AAFP), and the Centers for Disease Control and Prevention (CDC), current lung cancer screening guidelines are as follows:
- Annual screening with low-dose CT for adults 50-80 years old with a 20 pack-year history of smoking and are either current smokers or have quit smoking within the past 15 years
Annual lung cancer screening can stop once someone has not smoked for at least 15 years, is older than 80 years old, or has another medical condition that would limit their ability to undergo surgery for a lung cancer diagnosis.
A key point here is that former smokers should still be getting an annual low-dose CT screening until they have stopped smoking for more than 15 years.
Along with decreasing lung cancer mortality with early detection, this annual screening program is important because it can provide a baseline picture of someone’s lungs. This can be very beneficial if a lung nodule is seen but does not grow over time, increasing the probability of it being benign (non-cancerous). It can also monitor the stability of other lung findings, such as emphysema.
What Are the 10 Pillars of Lung Cancer Screening?
The 10 pillars of lung cancer screening refer to a step-wise approach to ensure the millions of Americans who qualify for lung cancer screening receive the proper care and are appropriately reimbursed for that care. These 10 pillars include:
- Eligibility: This refers to the eligibility criteria, including age and smoking.
- Education: This includes shared decision-making between the person and the healthcare provider to weigh the benefits and risks of lung cancer screening.
- Examination ordering: This helps determine which healthcare provider or group may be responsible for ensuring a qualified person receives their scan annually and without delay.
- Image acquisition: Under current recommendations, the best lung cancer screening imaging test is the low-dose CT scan.
- Image review: Images are reviewed by a radiologist who will look for any suspicious lung nodules or masses.
- Communication: This refers to communication between radiologists and the person’s healthcare provider to ensure there’s no delay in follow-up.
- Referral network: This is key when an abnormal finding is discovered to ensure the person promptly sees a proper specialist, such as a pulmonologist or thoracic surgeon.
- Quality improvement: This identifies areas of care that could be more effective or more efficient.
- Reimbursement: This refers to the payment for lung cancer screening. For example, lung cancer screening is covered by Medicare based on the USPSTF criteria along with one additional point that you’re asymptomatic.
- Research frontiers: Ongoing research regarding lung cancer screening guidelines is crucial as it could lead to changing criteria so even more people can qualify.
Are There Any Risks When Screening for Lung Cancer?
When screening for cancer, the benefits should outweigh the risks. While LDCT scans are quick and painless, there are some risks that your healthcare provider should discuss with you ahead of time. These include:
- Radiation: Though the radiation exposure risk is small per scan, repeated LDCT screening tests over time may potentially lead to a higher risk of cancer in some people.
- False positives: False positives are findings on imaging tests that may look like cancer but ultimately are benign. These can lead to follow-up tests and thoracic surgery that have associated risks and costs. An example of this would be lung nodules that appear cancerous on LDCT screening but are then found to be benign on biopsy.
- Overdiagnosis: This is when some cases of cancer are found that may have never caused a problem for the person. For example, maybe a lung mass was found on LDCT that never would have grown or spread. This can then lead to follow-up treatment that otherwise may not have been needed. It’s unclear how often this happens.
Decrease Your Risk By Quitting Smoking
Since tobacco use causes most cases of lung cancer, a key factor that shouldn’t be left out when recommending lung cancer screening is the topic of smoking cessation (quitting smoking).
According to the American Lung Association, smoking cessation should always be discussed because the sooner a person quits, the sooner their risk for lung cancer and many other health conditions starts going down. Furthermore, avoiding secondhand smoke can also decrease the risk of developing lung cancer.
Early Detection Is Key
Lung cancer screening guidelines are in place to improve outcomes. To assess your risk for various types of cancer (including lung cancer), use Ezra’s risk calculator. In just a few minutes, you can see if you are high risk for various types of cancers.
With Ezra, you have the opportunity to get a low-dose CT scan to screen for potential lung cancer — and it only takes 5 minutes of your time. You can also get a full-body MRI, which can give you a wealth of information about 13 other organs. It only takes an hour, and can potentially detect over 500 medical conditions.
Lung cancer is one of the most common cancers in the United States, but lung cancer screening guidelines decrease lung cancer deaths through early detection. Along with quitting smoking, annual LDCT screening can improve outcomes. Be proactive about your health and explore which scans might be right for you today.
