{"id":2536,"date":"2022-09-28T13:54:37","date_gmt":"2022-09-28T12:54:37","guid":{"rendered":"https:\/\/springerhealthcare.nl\/france\/?p=2536"},"modified":"2023-01-24T15:53:56","modified_gmt":"2023-01-24T15:53:56","slug":"most-people-at-risk-for-lung-cancer-never-get-screened-heres-how-to-fix-that","status":"publish","type":"post","link":"https:\/\/springerhealthplus.nl\/shmigrate\/most-people-at-risk-for-lung-cancer-never-get-screened-heres-how-to-fix-that\/","title":{"rendered":"Most People at Risk for Lung Cancer Never Get Screened: Here\u2019s How to Fix That"},"content":{"rendered":"

[vc_row full_width=”stretch_row” content_placement=”middle” css=”.vc_custom_1663187695627{padding-bottom: 37px !important;background-image: url(http:\/\/springerhealthcare.nl\/wp-content\/uploads\/sites\/24\/2022\/09\/science_connect_back.png?id=2486) !important;background-position: center !important;background-repeat: no-repeat !important;background-size: cover !important;}” el_class=”sciencetitle”][vc_column][vc_custom_heading text=”Science Connect” font_container=”tag:h2|text_align:left|color:%23ffffff” use_theme_fonts=”yes” link=”url:https%3A%2F%2Fspringerhealthcare.nl%2Ffrance%2Fscience-connect-november-2022%2F”][vc_column_text css=”.vc_custom_1663186747780{margin-bottom: 40px !important;}”]A Springer Healthcare Initiative For Pharma Professionals<\/span>[\/vc_column_text][vc_column_text]JANUARY 2023
\n<\/span>[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=”.vc_custom_1538651642953{padding-top: 75px !important;}”][vc_column width=”3\/4″ css=”.vc_custom_1538657061395{border-right-width: 1px !important;padding-top: 0px !important;border-right-color: #8faec1 !important;border-right-style: solid !important;}”][vc_custom_heading source=”post_title” font_container=”tag:h1|font_size:40px|text_align:left|line_height:60px” google_fonts=”font_family:Merriweather%3Aregular%2Citalic|font_style:700%20regular%3A700%3Anormal” el_class=”title” css=”.vc_custom_1664358136969{margin-bottom: 30px !important;}”][vc_column_text el_class=”intro-box”]U.S. lung cancer screening guidelines miss people who have never smoked, as well as many women and Black people. Expanding outreach and eligibility could help.<\/strong><\/span><\/p>\n

Simar Bajaj<\/span>[\/vc_column_text][vc_single_image source=”featured_image” img_size=”full” el_class=”hero-img”][vc_column_text css=”.vc_custom_1667911625437{margin-bottom: 30px !important;}”]A lung scan showing a nodule in the lungs of a person who smokes. Such scans could help diagnose lung cancer at an early stage, when it might be treatable. Credit:\u00a0Pascal Pochard-Casabianca\/AFP\/via Getty Images<\/a><\/span>[\/vc_column_text][vc_column_text]In late 2014 then 40-year-old Katherine Benson was diagnosed with stage IV lung cancer and told she had less than a year to live. \u201cShe was stunned,\u201d says her father Rick Nolan, a former congressional representative of Minnesota. Benson had never smoked and was a young, healthy mother of four. \u201cShe\u2019s the last person you would expect to get something like this,\u201d Nolan says.<\/p>\n

Lung cancer kills\u00a0about 130,000 people in the U.S.<\/a>\u00a0every year\u2014more than breast and colorectal cancer combined. But early detection makes a dramatic difference: if diagnosed in its localized stages, lung cancer has an almost\u00a060 percent five-year survival rate<\/a>. That number drops to 7 percent with late detection.<\/p>\n

\u201cEvery day in the U.S., there\u2019s a jumbo jet full of people who are dying of lung cancer that could have had early detection,\u201d says Claudia Henschke, a professor of radiology at the Icahn School of Medicine at Mount Sinai in New York City. Indeed, most people at risk of developing lung cancer never get screened for it. Increasing outreach to at-risk groups and expanding eligibility could change that\u2014and save lives.<\/p>\n

Restrictive Guidelines and a Low Screening Rate<\/strong><\/p>\n

The\u00a0most recent guidelines<\/a>\u00a0from the U.S. Preventive Services Task Force (USPSTF), an independent advisory panel, recommend annual lung cancer screening with a low-dose computed tomography (LDCT) scan. In two large randomized controlled trials, such screening reduced lung cancer mortality by\u00a020<\/a>\u00a0to\u00a024 percent<\/a>. But to qualify for screening, a person must be 50 to 80 years old, have a smoking history of at least 20 pack-years (a pack a day for 20 years, two packs a day for 10 years, and so on) and currently smoke or have quit within the past 15 years. These criteria are designed to identify patients who are at the highest risk and most likely to benefit from LDCT scans, according to the USPSTF\u2019s vice chair Michael Barry, a primary care physician at Massachusetts General Hospital. The guidelines were also updated last year from even more restrictive ones set in 2013\u2014increasing the number of people eligible for lung cancer screening from\u00a08.1 million to 14.5 million<\/a>.<\/p>\n

Yet Douglas Wood, chair of the department of surgery at the University of Washington and chair of the National Comprehensive Cancer Network\u2019s Lung Cancer Screening Panel, thinks the new guidelines are still too stringent. For one thing, he says, the age maximum is arbitrary\u2014there is \u201cno evidence that once you turn 80, the harms outweigh the benefits\u201d\u2014and overrides what should be a decision made between patients and providers.<\/p>\n

Wood also disagrees with the USPSTF\u2019s third criterion, arguing that the risk from smoking does not follow a strict time cutoff. \u201cIf somebody stopped smoking 15 years ago, and they\u2019re worried about lung cancer, the only way they can be screened is to either start smoking again\u2014or to lie,\u201d he says.<\/p>\n

Barry dismisses the notion that the USPSTF guidelines could incentivize smoking. In revising these guidelines, \u201cwe did, in our simulation models, look at other [cutoff] points\u201d for the maximum age and period of smoking cessation, he says, \u201cand we came up with keeping with the [existing] recommendations.\u201d He points out that the major lung cancer screening trials did not include patients who quit smoking more than 15 years ago, so the USPSTF has followed their lead. \u201cOther guideline groups have other rules of evidence than we do,\u201d he says. But in general, the various guidelines \u201care certainly more similar than they are different.\u201d<\/p>\n

Nevertheless, some research suggests that the USPSTF\u2019s eligibility criteria\u2014which help determine Medicare and private insurance coverage\u2014leave out a lot of people. According to one estimate published this year in\u00a0JAMA Oncology<\/em>,\u00a035 percent<\/a>\u00a0of all patients with lung cancer would be ineligible for screening under the new guidelines. For Black women with lung cancer, the figure is about\u00a066 percent<\/a>. Because of their lower rates of cigarette use, on average,\u00a0Black Americans, Hispanic Americans<\/a>\u00a0and\u00a0women<\/a>\u00a0all experience significant disparities in lung cancer screening eligibility. For example, according to a 2000 estimate, about half of women who get lung cancer worldwide have never smoked\u2014and thus would never have met the screening criteria.<\/p>\n

Barry says the updated 2021 USPSTF guidelines \u201cpreferentially increase the proportion of women, Black people and Hispanic people who are eligible for screening, so we\u2019ve made a pretty big step.\u201d He also emphasizes that the organization cares deeply about equity in screening, adding, \u201cWe\u2019re always eager for more evidence to fine-tune the guidelines as we go forward.\u201d<\/p>\n

A more immediate challenge for screening is that, even among those who are eligible, the actual number getting LDCT scans is very low. In fact,\u00a0only about 5 percent<\/a>\u00a0of people who met the old USPSTF guidelines were screened for lung cancer in 2015. That\u2019s compared with screening rates of about\u00a065 to 80 percent<\/a>\u00a0for colorectal, cervical and breast cancer in 2019.<\/p>\n

There is no one reason for this gap, according to Jamie Studts, a professor of medical oncology at the University of Colorado Anschutz Medical Campus School of Medicine. Part of the low rate may be that determining lung cancer screening eligibility can be difficult for overworked primary care providers, unlike other cancer screenings that have simple\u00a0age-based criteria<\/a>. The gap may also be related to the stigma and fatalism around lung cancer, as patients often think they will be blamed for having the disease and will not survive anyway.<\/p>\n

The key barrier, however, might be a lack of awareness among\u00a0physicians<\/a>\u00a0and\u00a0the public<\/a>: nearly 70 percent of people don\u2019t know that lung cancer screening is available at all. Other cancer screenings have been around for\u00a025 to 50 years<\/a>, whereas the USPSTF only began recommending lung cancer screening nine years ago. It may simply take time to embed LDCT scans into the culture of health care.<\/p>\n

Improving Awareness and Access<\/strong><\/p>\n

Patient advocates and researchers are hoping to speed up this embedding process, starting with renewed public awareness campaigns. Denise Lee, a 60-year-old retired public defender from California, knows their importance firsthand. Stuck in traffic on her way home from work, she saw a billboard telling her that lung cancer screening could save her life. Lee decided to bring it up with her doctor but was told she didn\u2019t qualify. A year later, after using an\u00a0online quiz<\/a>\u00a0to determine that she was finally eligible, Lee followed up with her physician, got the LDCT scan and was diagnosed with Stage IB lung cancer. Now a four-year lung cancer survivor, she simply says, \u201cA billboard saved my life.\u201d<\/p>\n

Awareness campaigns don\u2019t need to be fancy, but they should be more regionally targeted and personalized, Studts says. Since 2014 he has headed the Kentucky LEADS Collaborative, where he works with a network of community partners to meet face-to-face with primary care providers, educate them about the lung cancer screening guidelines and address their concerns. Studts also highlights the importance of combining smoking cessation and lung cancer screening discussions, because both are critical for reducing mortality and because primary care providers already do the former. Beyond Kentucky, there may also be an opportunity to leverage this messaging combination in national \u201cquit smoking\u201d ads. But Studts emphasizes the need for an empathy-first approach given that antitobacco campaigns have historically helped\u00a0increase lung cancer stigma<\/a>.<\/p>\n

Ashley Prosper, chief of cardiothoracic imaging at UCLA Health, thinks there\u2019s also a promising collaboration between lung cancer screening and other screening programs. In addition to doing outreach work to increase screening uptake in Black communities, Prosper works on the\u00a0Mammosphere Project<\/a>\u00a0to assess eligibility for lung cancer screening among women who already receive mammograms. She calls this approach \u201copportunistic screening,\u201d a method in which the high adherence rates of one kind of test are employed in service of another.<\/p>\n

Last year Hannah Hazard-Jenkins, a breast cancer surgeon and director of the West Virginia University (WVU) Cancer Institute, similarly launched\u00a0LUCAS<\/a>\u2014a lung cancer screening unit operating out of a tractor trailer. This 18-wheeler traverses the back roads of Appalachia, following in the path of WVU\u2019s mobile mammography unit\u00a0Bonnie\u2019s Bus<\/a>, and provides lung cancer screening to those in the most rural parts of the state regardless of insurance status. After local providers evaluate patients\u2019 screening eligibility, LUCAS arrives to perform the LDCTs. The scans are read back at WVU, and patients are referred for follow-up care close to home. \u201cWe have to be more creative about bringing health care to people, as opposed to always forcing them to us,\u201d Hazard-Jenkins says.<\/p>\n

Expanding Eligibility<\/strong><\/p>\n

Another way to facilitate screening might be to simply expand testing criteria, Henschke says. Since 2001 she has led an initiative to open lung cancer screening to anyone\u00a0age 40<\/a>\u00a0or older<\/a>, regardless of smoking history, as part of a research protocol. \u201cClearly you are going to find more lung cancers in people who have a greater smoking history,\u201d she says, \u201cbut\u00a0one quarter<\/a>\u00a0of people diagnosed each year with lung cancer are never smokers.\u201d Henschke doesn\u2019t want to deny these patients a lifesaving tool. Nolan, the former congressman, agrees with her and similarly wants lung cancer screening to be covered for everyone age 40 or above. He helped craft\u00a0Katherine\u2019s Lung Cancer Early Detection and Survival Act of 2020<\/a>\u00a0(named for his daughter) to make this a law. Although a\u00a0revised version of the bill<\/a>\u00a0was introduced in Congress last year, it hasn\u2019t yet been voted on.<\/p>\n

If passed, this act would represent a major shift from the USPSTF guidelines. Nolan says that it would open access to individuals who do not meet the age criteria but are still at high risk of lung cancer because of family history, exposure to the radioactive gas radon or other risk factors unrelated to smoking. \u201cI think extending the screening criteria, like at Mount Sinai, is appropriate if it\u2019s done as part of a clinical trial,\u201d Wood says. He is more cautious about making this expansion a law, however. \u201cUnfortunately, as much as I see patients every week that have never smoked and have lung cancer, it is still uncommon,\u201d Wood adds. \u201cAnd there\u2019s a trade-off in terms of benefits and harms.\u201d<\/p>\n

Balancing Risks and Benefits<\/strong><\/p>\n

Barry says potential harms include false-positive results that lead to anxiety and additional testing\u2014and the overdiagnosis and treatment of small lung nodules that would never have become life-threatening. The radiation exposure from the scan itself can also increase cancer risk. Prosper acknowledges these considerations and the need to discuss them with patients. She notes, however, that radiation risk is minimal with the LDCT scan\u2014equivalent to six months of\u00a0natural background radiation<\/a>\u2014and that false-positive rates are declining. These rates were 22 percent for the baseline scan and 27 percent for follow-up scans in the 2011 National Lung Screening Trial but dropped to\u00a05 to 13 percent<\/a>\u00a0with the Lung CT Screening Reporting and Data System (Lung-RADS), a classification tool that standardizes radiologists\u2019 reporting and follow-up recommendations.<\/p>\n

Hazard-Jenkins acknowledges that overdiagnosis is indeed a significant problem in the case of breast cancer. But for lung cancer, she says, \u201cat the moment, I\u2019m not sure you could overscreen because we\u2019re so profoundly underscreening.\u201d<\/p>\n

Ultimately, the stakes involved in lung cancer screening\u2014and in getting it right\u2014are immense. \u201cPolicy makers have to understand that lung cancer screening is currently the most significant missed opportunity to change cancer outcomes bar none,\u201d Studts says. Though experts disagree on the best ways to deploy LDCT scans, nearly all of them agree that the 5 percent screening rate is unacceptable.<\/p>\n

A couple of hours before Benson died, Nolan told her, \u201cI\u2019m looking forward to being with you as soon as possible.\u201d She responded, \u201cNo Dad, not until you get my bill passed.\u201d Nolan says he\u2019s working on his daughter\u2019s dying wish to help save the hundreds of thousands of people in the U.S. who still die from lung cancer every year.<\/p>\n

Copyright \u00a9 2022, Scientific American, Inc.<\/p>\n

About the author(s)<\/h4>\n

Simar Bajaj<\/strong>\u00a0is a student studying the history of science at Harvard University. He has previously written for\u00a0TIME<\/em>,\u00a0The Washington Post<\/em>,\u00a0The Guardian<\/em>,\u00a0Smithsonian Magazine<\/em>, and\u00a0The New England Journal of Medicine<\/em>. Follow him on Twitter\u00a0@SimarSBajaj<\/a>.[\/vc_column_text][\/vc_column][vc_column width=”1\/4″ css=”.vc_custom_1538657003956{padding-top: 0px !important;padding-bottom: 0px !important;}”][vc_custom_heading text=”ISSUES” font_container=”tag:h3|font_size:12px|text_align:left|color:%23333333|line_height:18px” use_theme_fonts=”yes” el_class=”titlewidget”][vc_column_text el_class=”columnflex” css=”.vc_custom_1664403914696{margin-bottom: 40px !important;}”]

October 2023<\/a><\/p>\r\n

September 2023<\/a><\/p>\r\n

August 2023<\/a><\/p>[\/vc_column_text][vc_custom_heading text=”OTHER ARTICLES IN THIS ISSUE” font_container=”tag:h3|font_size:12px|text_align:left|color:%23333333|line_height:18px” use_theme_fonts=”yes” el_class=”titlewidget” css=”.vc_custom_1667911596966{margin-bottom: 15px !important;}”][vc_basic_grid post_type=”post” max_items=”3″ element_width=”12″ orderby=”rand” item=”538″ grid_id=”vc_gid:1674575620239-52f35bbc-c850-7″ taxonomies=”24″][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"U.S. lung cancer screening guidelines miss people who have never smoked, as well as many women and Black people. 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