Updated 2021 Lung Cancer Screening Guidelines Can Save Even More Lives

Lung cancer screening with low-dose CT scans is so effective in detecting early lung cancers that the U.S. Preventive Services Task Force has updated and expanded its screening recommendation to now include those that meet all of the following criteria:

• Anyone over 50
• With a 20-pack-year history
• Currently smoke or have smoked in the last 15 years

Lung cancer is the second most common cancer and the leading cause of cancer death in the United States. Over 225,000 people will be diagnosed with and over 135,000 people will die this year from lung cancer. The U.S. Preventive Services Task Force’s initial lung cancer screening guidelines that were issued in 2013 had the potential to save 12,000 lives annually.  But now, given the updated 2021 Guidelines, they estimate that 24,000 lives can now be saved annually if implemented. The largest increase in lives saved will be among women and minority men, who were not adequately captured under the initial guideline parameters.

The amount of radiation used to perform a CT scan screening is extremely low, and people should not be reluctant to have this test performed. The radiation from a screening scan is less than what a person is exposed to each year from background radiation. The average amount of annual radiation exposure per person from the sun and other sources is 2.4 mSv (milliSeivert), while the amount of radiation from a screening exam is between 0.65 to 2.26 mSv.

Unfortunately, available data show that the use of lung cancer screening in the community is low, with only 14% of eligible smokers being screened within the last year, according to the just-issued guidelines. Physicians and their patients need to have frank conversations about a patient’s smoking habits, and physicians need to be sure to suggest screening for eligible individuals if we want to further stem deaths from lung cancer. This requires two important things to happen:

• Physicians must avoid implying guilt or smoke-shaming patients, so that patients are encouraged to disclose their actual smoking histories.
• Patients need to have an honest discussion with their physicians about how much they smoke.

Given this, physicians and patients can then have a meaningful conversation about cessation therapy and lung cancer screening. 24,000 Lives depend on it.

*In addition to being an attorney, Mr. Leone is also a Board-Certified radiologist.