Pulmonology and Critical Care Nurse Practitioner Jeanne Millett, left, and pulmonologist Dr. Thomas Smith review lung cancer screening scans at Albany Medical Center Friday, February 5, 2016 in Albany, NY. (Photo by John Carl D’Annibale/Albany Times Union via Getty Images)
Albany Times Union via Getty Ima
Screening for lung cancer remains strikingly inadequate, with reported screening rates of up to 16% according to American Lung Association. This means that fewer than 1 in 5 people who qualify for low-dose CT, the lung cancer screening test, actually get the test. This statistic is alarming since lung cancer is the leading cause of cancer death in both men and women.
According to the United States Preventive Services Task Forcepeople between the ages of 50-80, who have a smoking history of 20 or more pack-years and are current smokers or have quit within the past 15 years should be screened annually for lung cancer with a low-dose CT scan. This type of study takes less than five minutes to perform and involves special types of x-rays that take pictures of your lungs while you lie on a table. Research shows that screening with this test reduces mortality by 20%. Despite the clear benefit, screening rates remain abysmal. Here are some reasons.
Patient Factors
Patient awareness remains a major barrier to screening. Many smokers or those who are eligible for screening do not even know that lung cancer screening exists or what a low-dose CT scan of the chest is. A Early detection survey 2023 sponsored by the Prevent Cancer Foundation revealed that two in five respondents were unable to identify the exact description of a lung cancer screening test.
Additional obstacles they include fear of a cancer diagnosis, stigma associated with being labeled a smoker, and concerns about radiation exposure from a CT scan. The study delivers about 1 to 4 millisieverts of radiation to the body, which is four to five times less than a regular chest CT scan would deliver. This amount of radiation is also equivalent to the amount of radiation one would receive from six months of exposure to the environment in the environment, exposure that all humans receive naturally.
Physician Factors
Primary care physicians are the doctors who usually discuss the importance of screening tests with patients, whether they should have them, and the risks and benefits associated with them. Research shows that fewer than 10% of doctors regularly discuss lung cancer screening with their patients, according to a study published in Cancer Epidemiology, Biomarkers & Prevention. Some physicians have reported uncertainty about eligibility rules, how to manage incidental nodules on chest X-rays, and finding time to arrange shared decision-making communication with their patients.
Furthermore, although most low-dose screening studies are covered by Medicare, Medicaid, and private insurance companies, the need for prior authorizations or even copayments from some insurance providers may prevent both physicians from recommending the study and patients from going to imaging centers for screening.
USPSTF November meeting cancelled
The USPSTF, a scientific panel of national experts in preventive and evidence-based medicine, periodically provides recommendations to the American public about which screening tests should be done for the American public based on age and risk factors. Their meeting that was scheduled to take place November has been cancelled, after their meeting in July was also abruptly cancelled.
The downstream effect of such cancellations could lead to delayed guideline updates, confusing public health messages, and uncertainty from patients and physicians about which tests will be covered by health insurers, since most insurance companies provide free coverage for USPSTF-recommended preventive services. The end result could mean fewer Americans being screened for the deadliest cancer, worsening health outcomes for cancer survivors.
It is clear that screening for lung cancer saves lives. Consistent diligence by the USPSTF in reinforcing evidence-based guidelines in conjunction with physicians communicating the importance of screening testing will be necessary to ensure that those eligible for the study receive it. Strengthening patient education and community outreach to address fear and stigma must also remain priorities to move the needle on improved lung cancer screening rates.
