Group advises scans for smokers

Millions should be screened

An additional 5 million Americans who smoke or used to smoke should undergo annual screenings for lung cancer — the No. 1 cancer killer in the United States — according to an updated guideline issued Wednesday by the American Cancer Society.

The broadened recommendations apply to about 19 million people who the cancer group said would benefit from yearly low-dose computed tomography scans. CT scans provide detailed images of the lungs, allowing for improved cancer detection at an earlier stage, when the disease is more treatable.

In the biggest change, the new guideline recommends that people continue to get annual scans even if they stopped smoking more than 15 years ago. The previous recommendation, issued a decade ago, said people should discontinue screening 15 years after quitting smoking. Under the new guidance, those who stopped getting scans after 15 years should resume getting screened, the cancer society said.

The new guideline, published in the cancer society’s journal, CA: A Cancer Journal for Clinicians, also recommends screening for people 50 to 80 years old. The previous guidance applied to ages 55 through 74.

Robert Smith, senior vice president for early cancer detection science at the cancer society and lead author of the guideline, said the change reflects the fact that lung cancer risk continues to rise as former smokers age, no matter how long it has been since they quit smoking. The risk remains “quite high,’’ though it is lower than if smokers had continued to smoke, he added.

In addition, the guideline was broadened to include people with a less intense smoking history. The new recommendation applies to people who smoke or used to smoke the equivalent of one pack of cigarettes a day for 20 years. The previous guideline was for people who smoked the equivalent of one pack of cigarettes a day for 30 years.

The mortality rate for lung cancer has declined sharply in recent decades because of plummeting smoking rates, but the health toll remains high. In 2023, the cancer society estimates, there will be about 238,000 new cases of lung cancer in the United States and more than 127,000 deaths, accounting for 20 percent of all cancer fatalities. Cigarette smoking is the main cause, responsible for about 80 percent of cases.

‘’We face an enormous challenge in reducing lung cancer deaths, but we have better opportunities than in the past’' because of CT scans and medications such as immunotherapy, Smith said. Immunotherapy, which has emerged in recent years as an important cancer treatment, marshals the immune system to attack malignancies.

Experts emphasize the importance of detecting lung cancer before it spreads. The five-year survival rate for non-small-cell lung cancer, the most common type of lung cancer, is 65 percent for patients in which the cancer has not spread outside the lung, according to the cancer society. The survival rate is 37 percent for cancer that has spread to nearby parts of the body or lymph nodes and only 9 percent for cancer that has spread to more distant parts of the body.

The new guideline is in closer alignment with the recommendations of the United States Preventive Services Task Force, an independent panel of experts that assesses the effectiveness of preventive health care. Because the task force endorses annual lung cancer screening, most insurers must cover it without imposing cost-sharing on patients.