Despite lung cancer screening guidelines for smokers being issued in 2013, the rate of lung cancer screening is abysmally low with only about 3% of eligible smokers undergoing low-dose CT lung cancer screening. The USPTFS guidelines are for long term smokers with a 30-pack year history or more of smoking who are between 55 and 80 years of age. Many early lung cancers detected on screening exams can be treated with an 85% cure rate, yet most cancers today are still diagnosed at a late stage with minimal survival. There are approximately 7 million smokers eligible for screening, but only 210,000 are being screened annually as recommended. Under the USPFS guidelines, 12,000 deaths could be avoided each year with screening. With expanded risk-based guidelines, another 5,000 lung cancer deaths could be avoided. Unfortunately, most long-term smokers are not made aware of and do not receive life-saving screening.
An article in the December issue of JAMA looked at potential reasons for the failure of lung cancer screening to be a regular part of medical care for smokers. The authors postulate there is an ostrich effect, by which smokers fearing they may have cancer prefer to not undergo screening – although no empirical evidence is presented. Physicians try to blame patients’ psychological barriers to testing as the reason. However, the problem seems to lie with the failure of the medical profession, and family practice doctors specifically, to know of and to recommend screening.
When family physicians recommend colon cancer screening, the likelihood of an individual going for colon cancer screening increases by 23-fold. Unfortunately, most family practice doctors are not recommending lung cancer screening for their long-time smoking patients. A survey of family physicians in South Carolina showed that most had an incorrect understanding of low-dose CT scanning and its effectiveness, resulting in limited referrals. This shows that physician education must increase and more patients need to be referred for screening. The failure to diagnose lung cancer is a medical error.
Evidence-based medicine is held out as the gold standard for treatment guidelines. Screening guidelines for breast, colon, prostate and skin cancer are routinely followed by physicians. The failure of primary care doctors to recommend low-dose CT scanning to screen long-term smokers for lung cancer can be overlooked no longer. It is time to make primary care physicians follow the standard of care for lung cancer screening – over 17,000 lives a year depend on it. Smokers need screening.