Under medical guidelines first introduced in 2012, physicians are supposed to discuss lung cancer screening in long-term smokers and ex-smokers. Unfortunately, less than 10% of doctors talk about screening with long-term smokers today. The low rate of patient-reported physician patient discussions is caused by negative attitudes among physicians about lung cancer screening and misunderstanding the information about its benefits for individual smokers.
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.
Public health warnings have been effective in getting more Americans to stop smoking cigarettes, but lung cancer still kills more Americans than any other cancer. The percentage of Americans who smoke has decreased by half over about the last 30 years, from 30% in 1980 to 15% in 2012, but there are still over 150,000 deaths a year. Most cancers are still diagnosed at an advanced stage today. In the long run, quitting smoking will reduce lung cancer deaths 20 years from now; however, in the short run, it's not enough because most lung cancer deaths occur in ex-smokers who remain at risk even after they stop. Smokers need screening for lung cancer annually for 15 years after quitting.
CT Lung Cancer Screening Guidelines could detect 54,900 more lung cancer cases during a 5 year period if covered by Medicare. Most cancers would be diagnosed at an earlier more treatable stage. In fact, the number of early stage cancer diagnoses would double from 15% to 33%, while the number of patients diagnosed with advanced cancers would decrease from 57% to 40%. Seventeen percent (17%) fewer patients died from lung cancer in the screening group compared with the non-screening group. Medscape Medical News reported that Joshua A. Roth, PhD, MHA told attendees at the 2014 Annual Meeting of the American Society of Clinical Oncology of these cost estimates. However, Medicare has yet to decide whether or not to cover the new screening guidelines from the United States Preventive Services Task Force (USPSTF)
Lung cancer screening in high-risk individuals is now also recommended by the United States Preventive Services Task Force (USPSTF), following other professional organizations that have recommended the same. There had been controversy as to whether or not screening by way of chest x-rays and CT scan provided a true benefit in the fight against this cancer. Based on an article in the Annals of Internal Medicine, annual screening with low-dose CT for people at high risk because of age and smoking history is now the recommended standard. High risk individuals are current and former smokers aged 55 to 80 years of age with a smoking history of 30 pack years or who have smoked in the last 15 years.
Lung cancer screening of all current and former smokers with low-dose CT scanning would result in preventing 12,000 deaths in the United States each year. A study in Cancer reported that, compared with chest x-ray, CT screening would reduce lung cancer mortality by 20%. The total number of potentially avoidable deaths could even be greater. The patients in the study were 55 to 74 years of age and smoked at least one pack a day for 30 years. Even though these patients are at risk for cancer, screening is generally performed by chest x-ray which misses 20% of tumors.