New lung cancer screening guidelines more than double number of Americans eligible
More Americans now qualify for yearly scans to detect lung cancer, according to new guidelines that more than double the number of people eligible and might help more Black smokers and women get screened.
Lung cancer is the nation’s top cancer killer, causing more than 135,000 deaths a year. Smoking is the chief cause, and quitting the best protection.
Usually, lung cancer is diagnosed too late for a good chance at survival. But some Americans who are at especially high risk get an annual low-dose CT scan to improve those odds.
Those who are eligible, according to the U.S. Preventive Services Task Force, include anyone between 50 and 80 who has smoked at least 20 “pack-years” and either still smokes or quit within the last 15 years. A “pack-year” means smoking a pack of cigarettes a day for a year or an equivalent amount. So someone could qualify by going through a pack a day for 20 years or two packs a day for 10 years.
Since 2013, the scans have been recommended for the heaviest smokers — those with at least 30 “pack-years” — and people who are at least 55 years old.
Now, the task force has updated the guidelines, published in the Journal of the American Medical Association, after newer research showed lighter, younger smokers benefit, too. About 15 million people are estimated to meet the new criteria — nearly double the prior number.
The task force made two significant changes: Yearly lung cancer screenings are now recommended to start at age 50, and smoking intensity has been reduced from 30 to 20 pack-years.
That’s expected to increase eligibility from 6.4 million adults to 14.5 million.
The task force recommendation means insurers are now required to offer the screening without a copay to people who meet the criteria.
The changes “mean more Black people and women are now eligible for lung cancer screening, which is a step in the right direction,” according to Dr. John B. Wong, a task force member on staff at Tufts Medical Center outside Boston.
The panel said African Americans and women tend to be less-heavy smokers and might not have met the earlier screening threshold despite being at risk for lung cancer.
In an editorial in the medical journal JAMA Surgery, cancer specialists welcomed the changes.
But “unfortunately, lowering the age and pack-year requirements alone does not guarantee increased equity in lung cancer screening,” Dr. Yolonda Colson and colleagues at Massachusetts General Hospital wrote.
Her team cited “formidable” barriers to that, including poor access to health care and even doctors not familiar enough with the screening to identify good candidates and help them decide.
One recent study found that just 14% of people eligible for lung cancer screening under the prior guidelines had gotten it. In contrast, 60% to 80% of people eligible for breast, colon or cervical cancer screening get checked. That’s partly due to racial inequities, financial barriers and a lack of awareness and education.
People offered lung cancer screenings also
must consider the risks of invasive testing to detect whether an abnormality spotted by the scan really is a tumor. Lung biopsies occasionally cause serious, even fatal, complications.
People of color who are diagnosed with lung cancer face worse outcomes compared with white Americans — in part because they are less likely to be diagnosed early. Compared with white Americans, Black Americans with lung cancer are 16% less likely to be diagnosed early, Latinos are 13% less likely, and Asian Americans or Pacific Islanders, and Native Americans are 14% less likely, according to the American Lung Association.
But just expanding the eligibility pool won’t address racial disparities, according to an editorial by University of North Carolina School of Medicine professors published in JAMA.
“Implementation will require broader efforts by payers, health systems and professional societies, and, in the future, a more tailored
individual risk prediction approach may be preferable,” said Dr. Louise M. Henderson, a co-author of the editorial who is a professor of radiology at UNC School of Medicine.
Financial barriers could also worsen the racial disparities. Medicaid isn’t required to cover the task force’s recommended screenings, which could lead to greater inequities if recommendations expand to include more people.
People who receive Medicaid are twice as likely to be smokers than those with private insurance, 26.3% compared with 11.1%, Henderson said, and they are also disproportionately affected by lung cancer.
“This is a significant issue, particularly in the nine states where Medicaid does not cover lung cancer screening,” Henderson said.
Those states are North Dakota, Wyoming, Nebraska, Utah, Texas, Alaska, Mississippi, Alabama and Florida.