Lung Cancer Screening Guidelines: Who Qualifies and Why Many Miss Out
Lung cancer often grows without symptoms, but annual low-dose CT scans can cut the risk of dying from the disease by 20%. Yet many eligible Americans skip screening, leading to tens of thousands of preventable deaths each year.
Lung cancer can develop silently for years, often without any obvious symptoms, making early detection through screening one of the most effective ways to reduce deaths from the disease. Yet a large share of Americans who qualify for screening do not get it, a gap that experts say translates to tens of thousands of preventable deaths annually.
Daniel J. Boffa, M.D., chair of the American College of Surgeons Commission on Cancer and a thoracic surgeon at Yale University, said lung cancer screening is «one of the most powerful ways» to improve survival. «It reduces the chance of people dying of lung cancer by 20%,» he said. Boffa added that the number of eligible people who skip screening results in «tens of thousands of preventable deaths every year.»
Current guidelines from the American Cancer Society recommend an annual low-dose CT scan for people aged 50 to 80 who currently smoke or have a history of smoking, or who have at least a 20 pack-year smoking history. A pack-year is calculated by multiplying the number of packs smoked per day by the number of years smoked. Before deciding to get screened, individuals should talk with their healthcare providers about the purpose of the screening, how it is done, and its benefits, limits, and possible harms. Those who still smoke should be counseled about quitting and offered resources to help.
The guidelines also state that people with serious health problems that will likely limit their lifespan should not be screened, nor should those who would not be able to get treatment if lung cancer were detected. For never-smokers, there is currently no set screening guideline, even though about one in seven lung cancers affects someone who has never smoked. Boffa said finding never-smokers who would benefit from screening is an «intense area of research.» For now, he suggested that people with a direct family history of lung cancer who never smoked should consider annual screenings, as should higher-risk groups such as Asian women. He predicted that better guidance for at-risk never-smokers could arrive within the next year or two.
In most cases, early-stage lung cancer does not cause symptoms, according to Lary Robinson, M.D., an oncologist at Moffitt Cancer Center in Tampa, Florida. When symptoms do appear, they are most often related to the lungs and include a persistent cough, shortness of breath, or coughing up blood. Unexplained weight loss can result from any form of cancer, and neurological symptoms such as persistent headaches may also warrant a doctor’s visit.
Boffa noted that most screenings detect a lung nodule or other abnormality, which is more often an infection, scar, or inflammation than a tumor. In about one-third of patients, screenings also detect unrelated health issues, including hardening of the heart arteries or a nodule elsewhere in the body. «The reality is over 99% of nodules are actually benign,» he said. «And so, you need to have a conversation about what you are going to do with that information.» He stressed the importance of having that conversation ahead of time so expectations are set, noting that finding something is not uncommon but most of the time it will not affect how long a person lives.
The CT scan itself takes only a couple of minutes and does not involve an enclosed space like an MRI, so people who get claustrophobic usually do not have a hard time with lung cancer screening, Boffa said. Results typically come back within a few days. He also pointed to advances in treatment that have improved survival even at advanced stages, and he urged people not to view screening as a pathway to a terminal diagnosis. «People are really reluctant to be diagnosed with lung cancer because it does carry a stigma,» he said. «For years, there was a reputation that it was a terminal diagnosis. It’s just been amazing what research has done for lung cancer.» For those over 50 with a history of smoking, Boffa reiterated that getting screened is «one of the most powerful things you can do to reduce your chances of having your life shortened by lung cancer.»
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