Although doctors continue to encourage patients to not smoke, it is an addiction that has afflicted millions of Americans. We now know that that even smokers who can’t stop smoking can be saved from dying of lung cancer if diagnosed early.
In 2006, medical research published in the New England Journal of Medicine showed that screening by a low-dose CT scan (a non-invasive, 15-minute scan using minimal radiation) found early lung cancers in smokers, 85% which were clinical stage 1 and curable with surgery alone. Smokers who underwent removal of an early cancer had an 88% chance of a 10-year survival, compared with 0% survival for patients with stage 1 lung cancer who did not receive treatment. In 2011, another landmark study published in the New England Journal of Medicine confirmed that screening of long-term smokers with low-dose CT scans reduces mortality from lung cancer. Other major medical organizations concurred with the study – including the American Cancer Society, American Association for Thoracic Surgery, American College of Chest Physicians, and the National Comprehensive Cancer Network – and published guidelines for screening smokers for lung cancer. In December 2013, the U.S. Preventive Services Task Force (USPTFS) issued primary care recommendations for screening smokers for lung cancer that were projected to save over 12,000 American lives a year.
Specifically, the 2013 guidelines recommended yearly low-dose CT scanning for patients over 55 with a 30 pack-year history of smoking and having smoked within the last 15 years. Despite the fact that the cost of screening costs about $400 and is covered by Medicare and health insurance as part of cancer screening programs, less than 4% of eligible smokers are screened in the US, resulting in more than 12,000 needless deaths from lung cancer each year that could have been prevented with early diagnoses recommended by these screening guidelines.
But in July 2020, the USPTFS updated their recommendations for lung cancer screening:
These new recommended guidelines reduce the age of eligibility for screening to 50 (from 55) and the amount of smoking to a 20 pack-year (from a 30 pack-year history). After review of the final comments period ending on August 3,2020, these recommendations are set to become the new lung cancer screening guidelines for smokers and will expand the benefit of early cancer detection to twice as many U.S. smokers, including more women and African-Americans who more often fell outside the prior age and smoking history requirements. As a result of the updated guidelines, the number of Americans eligible for annual lung screening by a low-dose CT scan under the new guidelines will be doubled.
Unfortunately, with less than 4% of eligible smokers being offered lung cancer screening under the current guidelines, instead of saving 12,000 Americans annually, we are only saving 500 from otherwise avoidable death. The reasons for this are unclear. It may be a bias of the medical profession against smokers or a patient’s reluctance to be honest about their smoking history.
Implementation of these updated lung cancer screening guidelines later this year could save over 25,000 American lives a year, but only if primary care physicians screen for eligible smokers and recommend lung cancer screening for those that qualify.
Regardless of the reasons, it is time for patients and primary care physicians to have honest conversations about smoking and lung cancer screening. Patients and physicians need to be aware that smoking is not a character flaw but an addiction; smokers are not to be blamed for smoking. Shame and blame will not stop deaths from lung cancer. Doctors need to diligently inquire into patients’ life-time smoking histories and recommend lung cancer screening for eligible patients. Patients need to honestly report current and past smoking histories. If physicians fully incorporate low-dose CT screening for smokers into their practices, the life saving benefits of lung cancer screening can be realized.