Who Should Get Screened for Lung Cancer Now?

Are you eligible for lung cancer screening?

Earlier this week, the American Cancer Society (ACS) released updated lung cancer screening guidelines that will allow more than 5 million additional U.S. adults who smoke and formerly smoked to get screened for lung cancer.1

“With new data from the NELSON trial that was published in 2020, we now had additional evidence that lung cancer screening was effective in people who start screening at age 50 (vs. 55), and with lighter smoking histories,” said Robert A. Smith, PhD, senior vice president of cancer screening at ACS and director of the ACS Center for Cancer Screening.

“This recommendation expanded the pool of people who ever smoked by 32%, from about 8.1 million to 14.3 million individuals,” he said.

The NELSON trial Smith mentioned showed that when using low-dose CT scanners, lung cancer mortality can be reduced for former and current smokers, especially when the disease is caught early.2

Here is what you need to know about the new guidelines and who they may impact.

How the New Guidelines Have Changed

Before these new guidelines, the ACS recommended regular lung cancer screenings for people between the ages of 55 and 74 with at least a 30-pack per year smoking history.3

This screening recommendation was for those who currently smoke and those who quit smoking less than 15 years ago. Under the new guidelines, it doesn’t matter when a person stopped smoking—it’s still encouraged that they are screened for lung cancer.1

“The evidence we have assembled shows that among people who formerly smoked, their risk of lung cancer continues to [rise] with their increasing age,” said Smith.

He explained that the elimination of “years since quit” criteria is expected to prevent 21% more lung cancer deaths and add years of life to those who follow the screening guidelines.

According to Smith, there are three primary changes to the guidelines. These include:3

• Expanding the age range for lung cancer screening to 50 to 80 years old (from 55 to 74 previously)
• Lowering pack-year history for lung cancer screening to 20+ pack years (from 30+ pack years previously)
• Eliminating standard years since quitting for lung cancer screening (previously it was up to 15 years since quitting)
  

  How The Updated Guidelines Will Impact Diagnosis

  The goal of these new guidelines is to reduce the number of people who die from lung cancer—especially since this type of cancer is the overall leading cause of cancer death in the U.S.1

  With the new guidelines, cancer experts hope to change that trajectory, especially since the survival rate for lung cancer is impacted by how early it is found.

  Screening is vital because it can potentially diagnose lung cancers at their earliest possible stages before patients ever develop symptoms, Michael Wert, MD, director of the James Lung Cancer Screening Clinic at The Ohio State Wexner Medical Center told Health.

  He explained that the majority of lung cancers are diagnosed once a patient has become symptomatic, which usually means the cancer is already advanced and less amenable to curative measures like surgery.

  “Lung cancer screening is absolutely proven to save lives,” he said.

  In addition to early diagnosis, early screening also improves outcomes.

  Royce Calhoun, MD, the medical director of thoracic surgery at St. Elizabeth Healthcare in Edgewood Kentucky, explained the reason lung cancer is so deadly is that typically more than 70% of cases are found at late stages and are hard to cure.

  “In this population of patients with advanced disease, the overall survival rate is approximately 10%,” he said. “If lung cancer is found early, in stages I and II, it is very curable. This is especially true of stage I—[which is] a tumor the size of a marble in the lung that has not spread. [It] has cure rates greater than 70%.”

  How Many Lives Will Be Saved?

  Typically, screening finds the early stage cancers while the later-stage cancers are found when people have symptoms, Daniel Boffa, MD, division chief of thoracic surgery and clinical director of the Center for Thoracic Cancers at Yale Cancer Center and Smilow Cancer Hospital told Health.

  “Screening works by finding dangerous cancers before they do dangerous things,” he said. “Overall people that participate in lung cancer screening reduce their chances of dying of lung cancer by 20%.”

  In fact, according to Boffa, for every 300 people who undergo lung cancer screening, a patient’s life will be saved.

  “The problem is over 90% of people who are eligible, do not participate in lung cancer screening,” he said. “If even half the eligible people started to participate, it is estimated that 20,000 lives would be saved every year in the United States.”

  Who Is Not Eligible for Screening?

  According to Smith, the ACS does not recommend screening to adults younger than age 50, or with less than a 20-pack year history of smoking.

  “We also do not recommend lung cancer screening in individuals with life-limiting co-morbidity or less than five years expected longevity,” he said.

  Additionally, people who have never smoked are not recommended for screening, even though one out of seven lung cancers is found in a person who never smoked, explained Boffa.

  “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.

  Why It’s Important to Get Screened

  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 over50 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.”