November is Lung Cancer Awareness Month.
Lung cancer has been the leading cause of cancer death in the United States for many years. And it accounts for about one in five cancer deaths nationwide. In fact, more Americans die from lung cancer than from breast, prostate and colon cancer combined.
The American Cancer Society (ACS) estimates that about 125,000 Americans will die from lung cancer this year – and about 60,000 of those will be women.
Smoking remains the most common cause of lung cancer, with the ACS estimating that tobacco use causes about 8 in 10 cases of lung cancer.
But there is also some good news. The number of new cases of lung cancer has fallen by an average of 2.4% each year, according to the latest statistics. And death rates have fallen by an average of 4.2% per year over the past decade.
Anti-smoking efforts have helped many Americans quit smoking or, better yet, never start. And lung cancer treatments have become much more effective over time.
Another factor is contributing to these improvements: lung cancer screening for people at high risk. Researchers estimate that lung cancer screening could reduce lung cancer mortality rates by up to 20%.
Here are some answers to frequently asked questions about lung cancer screening.
What is lung cancer screening?
Generally, health care providers use screening tests to check for disease in healthy people who have no symptoms. The goal of screening is to detect disease in its early stages, when treatment is most likely to be effective.
Lung cancer screening consists of a low-dose computed tomography (LDCT) scan of the lungs to look for lung cancer. This screening is currently only recommended for people at high risk of developing lung cancer.
To perform this quick and painless test, you lie on a table as it moves through a CT scanner to create clear images of your lungs.
Read: Symptoms of Lung Cancer >>
Who should be examined?
The US Preventive Services Task Force (USPSTF), a group that reviews scientific evidence to make recommendations for patient care, released its most recent recommendations in 2021. She recommends annual lung cancer screening for people who meet all of these requirements:
- Are between 50 and 80 years old
- You must have a smoking history of at least 20 pack-years (the number of packs of cigarettes smoked per day multiplied by the number of years you smoked).
- Are you still smoking or have you stopped smoking in the last 15 years?
Compared to previous versions, the current USPSTF guidelines lowered the age for starting screening from 55 to 50 and lowered the minimum number of pack-years from 30 to 20.
These changes have significantly increased the number of women – particularly black women – who are at high risk of lung cancer.
The ACS also has a lung cancer screening policy. There’s one important difference from the USPSTF guideline: The ACS recommends annual exams, regardless of how long you’ve stopped smoking.
What is a “pack year”?
Scientists who study tobacco use the term “pack-year” to measure how much people have smoked over time. Multiply the number of packs of cigarettes you smoked per day by the number of years you smoked. This is your packing year.
If you smoked two packs a day for 10 years, that’s 20 pack-years, which means you’re eligible for lung cancer screening. If you smoked a pack a day for 15 years, that’s 15 pack-years and is below the 20 pack-year threshold for screening.
Why can’t we screen everyone for lung cancer, even people who aren’t at high risk?
All screening tests carry potential benefits and risks. Therefore, you and your doctor should discuss your personal history and whether you should undergo a lung cancer screening. Shared decision making means reviewing this information and working together to create a plan for your care.
It is important to note that smoking is currently the only lung cancer risk factor considered in current screening guidelines.
Other possible causes of lung cancer such as air pollution, radon exposure, secondhand smoke and genetic mutations are not considered in today’s guidelines. Scientists are studying whether personalized screening approaches would identify more cases of lung cancer and potentially save more lives.
Read: How shared decision making can lead to better healthcare >>
What are the benefits of lung cancer screening?
The main benefit of lung cancer screening is the ability to prevent death from lung cancer by detecting it as early as possible.
The American Lung Association (ALA) reports that lung cancer screening detects more than half of lung cancer cases at an early stage when it is more treatable.
A study found that only about one in four cases of lung cancer were discovered at an early stage without screening.
What are the risks of lung cancer screening?
Lung cancer screening is unlikely to miss cancer, but it can happen. This is called a false negative result.
Test results that suggest a person has cancer when they don’t are called false positives. The ALA estimates that about 12-14% of a person’s first lung cancer screenings are false positive. But only about 6% of repeat scans show false positive results, as medical professionals compare scans over time to look for changes.
A potential downside to lung cancer screening is that it may identify cancers that may never have caused harm if ignored. In rare cases, lung cancer grows slowly and without symptoms. But any type of lung cancer diagnosis means your doctor will likely recommend treatment. And treating cancer in a way that is unlikely to harm you is called overtreatment.
LDCT screening also uses low-dose radiation to take images of your body. Over time, this radiation can cause health problems. However, it is important to know that LDCTs use much less radiation than traditional CT scans.
What are the hurdles to a lung cancer screening examination?
According to the ALA’s State of Lung Cancer Report, only 18% of eligible people received a lung cancer screening in 2022.
Several real-world barriers may prevent some eligible individuals from undergoing lung cancer screening. For example, some people at high risk may not know that they are eligible for lung cancer screening.
Some long-time or former smokers may also refrain from screening because they fear developing lung cancer or because they fear that people with lung cancer will be stigmatized and that they somehow deserve to be sick.
Transportation issues and physical access to LDCT screening centers can also deter people from undergoing screening. This is particularly true for people living in rural communities.
If you are eligible for a lung cancer screening, cost should not be a barrier. Medicare and most private insurance plans cover lung cancer screening at 100% for eligible individuals. This means you likely won’t incur any out-of-pocket costs – just like with mammograms and other screening tests. However, additional tests and follow-ups between examinations may incur costs, such as a co-payment or deductible.
This educational resource was created with support from Merck.
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