More than 50% of lung cancer is found in an advanced stage, making it harder to treat and leading to poor outcomes and death.
Simply put, screening for lung cancer saves lives. We need more of it.
Lung cancer is the leading cancer killer for men and women in the United States and far surpasses deaths from breast, colon, and prostate cancers combined.
It doesn’t have to be this way.
Over the past two decades, we have witnessed monumental advances in the early detection of lung cancer through low-dose computed tomography (CT) scans. According to the National Institutes of Health (NIH), use of this screening tool leads to early diagnosis and reduces lung cancer deaths in screened patients by 20%. Unfortunately, only a small percentage of those eligible for screening are taking advantage of this lifesaving tool.
Addressing barriers to care
Recent guidelines from the Centers for Medicare and Medicaid Services (CMS) offer a significant step forward in lung cancer screening coverage for the millions of Americans at risk for the disease. The guidelines lower the initial screening age to 50 from 55 and smoking history requirements to 20 packs per year from 30. These changes expand coverage and double the number of people eligible for lung cancer screening to 13.5 million.
We applaud CMS for moving in the right direction, but more must and can be done to increase lung cancer screening and save lives. First, CMS ages for screening eligibility range from 50 to 77. With 14% of lung cancer diagnosed in patients over 80, the screening age should be increased so we are not writing off a major swath of our population that deserves the same care and shot at life as anyone else. Second, CMS should discontinue the requirement that eligible patients undergo a “counseling and shared decision-making visit” before they are allowed a screening. This requirement does not improve outcomes and poses a significant barrier to screening for the many patients who are hesitant to seek care based on things like fear of stigma or distrust of the health care system.
Another barrier to screening that must be addressed involves social determinants of health, which include socioeconomic status, neighborhood characteristics, geographic location, and literacy levels. We know that people with poor social determinants of health not only have poor access to healthcare and are more vulnerable to poor health outcomes, but they are also more likely to smoke cigarettes. This situation creates a terrible recipe for poor lung cancer prognosis in our most underserved communities. More education about the availability and importance of lung cancer screenings in these at-risk communities must be a priority for public and private healthcare systems.
In addition, as the COVID-19 pandemic shed light on health disparities in our most vulnerable communities, the pandemic set us up for more hidden cases of lung cancer as lockdowns and fears prevented people from visiting their doctor for an extended period of time. Now more than ever, it is critical for those at risk for lung cancer to contact their health providers to request lung cancer screening, and for health providers to speak to their patients about the availability of life-saving screenings.
Finally, in addition to addressing barriers to care, the federal government must recognize other risk factors for lung cancer, like significant family history, occupational exposures, secondhand smoke exposure, radon exposure, certain lung disease, and cancer history, and expand screening criteria to include these at-risk people.
To save lives, we must break barriers to lung cancer screening and expand availability. Too many lives are at stake.