Although the past 20 years have brought great progress, lung cancer remains one of the most common—yet hardest-to-treat—types of cancer. But doctors are hopeful that expanding access to lung cancer screening might lead to an increase in the diagnosis of the disease during its earliest stages, when it can often be cured.
Screening with a low-dose CT (computed tomography) scan may be lifesaving for the approximately 15 million people who have become eligible since 2021, when the U.S. Preventive Services Task Force (USPSTF) expanded the criteria for recommended screening.
This fall, the American Cancer Society (ACS) also weighed in, recommending a low-dose CT scan for anyone who has a significant smoking history (more on the changing guidance below).
And yet, only about 6% of eligible people are getting the screening. “It is important that we try to understand and then remove barriers preventing millions of Americans at risk for lung cancer from getting screened,” says Lynn Tanoue, MD, MBA, director of the Lung Cancer Screening Program at Yale.
A lack of awareness among clinicians that lung cancer screening is available and covered by Medicare and other insurers is a major barrier, Dr. Tanoue adds. “Physicians and other medical providers may simply not know lung cancer screening has been proven to be effective in saving lives,” she says. “National efforts like Lung Cancer Awareness month [in November] and local efforts educating our medical communities are all important in overcoming this.”
Another big obstacle is that many people don’t know they have the option, explains Justin Blasberg, MD, MPH, a Yale Medicine thoracic surgeon. “We could save so many more lives if more people were screened. With significant advances in the field and new therapeutics, there is a possibility of a cure for more patients.”
For some smokers and former smokers, there is also a stigma surrounding screening—they feel they’ll be blamed for a highly addictive habit. “We need to continue to work on getting rid of this stigma,” says Dr. Tanoue. “No one should ever be blamed for having what could be a fatal disease.”
Screening may be especially important for Black men, who are hit harder by lung cancer than any other group; they tend to be diagnosed at younger ages and with a shorter history of smoking, and are more likely to die of the disease than other groups, adds Dr. Tanoue. “Importantly, in the original National Lung Screening Trial, which was a large study proving the benefit of lung cancer screening, Black men not only had an improvement in terms of fewer deaths from lung cancer, they also had fewer deaths from all causes, including cardiovascular disease, which suggests even more benefit from the screening,” she says.
Below, Yale Medicine doctors answered three important questions about lung cancer screening.
1. Are you eligible for lung cancer screening?
The USPSTF expanded its criteria for annual lung cancer screening to lower the eligible minimum age from 55 to 50 and reduce the number of required pack-years from 30 to 20. (One pack-year is the equivalent of smoking an average of 20 cigarettes—one pack—per day for a year.) These changes nearly doubled the number of U.S. adults now eligible for screening.
Below are the updated screening criteria:
- You are between the ages of 50 and 80
- You have a 20 pack-year smoking history
- You currently smoke or have quit within the past 15 years. If you have been screened already, a repeat screening is recommended every 12 months or as recommended by your provider.
Annual screening may be discontinued once a person has not smoked for 15 years, or has a health problem that limits life expectancy or the ability to have curative treatment.
While most private insurance providers must follow certain USPSTF recommendations, some organizations follow ACS’s guidelines, which go a little further by opening eligibility to everyone with a smoking history. Otherwise, their criteria are in line with the task force, recommending annual low-dose CT screening for people 50 to 80 who smoke (or used to smoke) and have a 20 pack-year history of smoking.
Those who don’t fit the criteria above but wonder if they should be screened based on other risk factors should discuss the possibility with their primary care provider. While smoking cigarettes or other tobacco products is the greatest risk factor, others include:
- Exposure to second-hand smoke
- Having a history of another cancer
- Hereditary factors, such as having a parent, child, or brother or sister who has had lung cancer
- Exposure to carcinogens, such as asbestos or radon
- Other lung problems, such as chronic obstructive pulmonary disease (COPD) or interstitial lung disease
It’s important to know that undergoing the scan in the absence of a high risk of lung cancer “just to check” isn’t necessarily a good idea, Dr. Tanoue adds. “The potential downsides of screening, mostly related to false positive findings that are not cancer but create worry and may trigger more evaluation, become magnified if the chance of developing lung cancer is low.”
2. What is lung cancer screening like?
Screening usually starts with a brief counseling session with your provider to discuss your risk for lung cancer and the potential risks and harms of screening, such as the chance of false positive or false negative results, as well as what the results might mean, including referrals to lung cancer specialists.
Screening is performed with a low-dose radiation CT scan, which can detect abnormalities before symptoms occur, when there is the best chance for a cure compared to more advanced-stage lung cancers. This takes about 5 minutes and is painless; there is no needle or contrast dye, no closed spaces, and no anesthesia.
Insurance usually covers the cost of screening for most patients who meet the criteria, and Medicare provides coverage up to age 77.
3. What if the screening finds an abnormality?
A specialized chest radiologist (a doctor with advanced skills in reading CT scan images of the lungs) will study the images for any lung nodules (spots in the lung). CT scans find small nodules frequently, and more than 95% are not cancerous. Rather, lung nodules can be the result of infections or remnants of previous smoking or other conditions, and are usually harmless.
In some cases, lung nodules might signal the need for more testing to make sure they aren’t cancerous, and this could include additional imaging, evaluation by a specialist, or a biopsy. “But when screening is used appropriately and in the right setting by experienced clinicians, the need for additional testing is low,” Dr. Tanoue says. “Stated simply, we do not want patients to have any tests they do not need.”
The USPSTF stresses that the best way to reduce a person’s risk of lung cancer is to quit smoking and stay smoke-free. There is support for people who want to quit. The Tobacco Treatment Program at Smilow Cancer Hospital offers counseling and medication, and is available to anyone 18 and older who wants support for quitting smoking or vaping.
The Smilow Cancer Hospital Lung Cancer Screening Program offers appointments on its website or by calling 1-877-YALEMDS.