Recent research has found that current lung cancer screening guidelines could be missing most cases, prompting calls for changes to detect the disease earlier, reports The Washington Post.
Jessie Creel’s cough started in May last year.
At the time, a primary care physician diagnosed the mother of three with pneumonia. But the antibiotics didn’t work and her cough persisted. Then, during a camping trip, she coughed up blood. She kept losing weight. She couldn’t sleep.
Six months later, Creel, then 42, was diagnosed with stage four lung cancer. She was active, a runner and a swimmer, didn’t drink, and had never even held a cigarette.
More diagnoses like hers are prompting cancer and public health experts to call for changes to lung cancer screening guidelines.
Under current recommendations, people are eligible for screening if they are 50 to 80-years-old and have a history of heavy smoking, either actively or in the past 15 years. But those guidelines exclude a large number of people who could have their cancer detected earlier, according to a study published recently in JAMA Network Open.
The study indicated that of the roughly 1 000 patients treated for lung cancer at Northwestern Medicine, only one-third met requirements for screening. The researchers noted that women, minorities and people who never smoked were disproportionately excluded.
“A majority of the lung cancer patients in this country would not meet the screening criteria as it exists currently,” said Ankit Bharat, the study’s lead author and executive director of the Canning Thoracic Institute at Northwestern Medicine. “If we have a broader screening programme, similar to breast and colon, then we would be able to detect substantially more patients at earlier stage.”
If screening were made available for anyone between the ages of 40 and 85, researchers estimate that nearly 94% of lung cancer cases could be detected, preventing at least roughly 26 000 deaths each year if even 30% of people got screened.
“Lung cancer is the biggest cause of cancer deaths in this country,” Bharat said. “It kills more people than breast, colon and prostate combined.”
He and other experts said the study’s findings highlight that the cancer should no longer be seen as just a smoker’s disease.
“If I had come in presenting a totally different phenotype of like a heavy drinker and heavy smoker, I would have been screened,” Creel said. “It would have been a different result. We have such stereotypes about what lung cancer looks like.”
How is lung cancer detected?
Those who are eligible for screening should get a low-dose CT scan annually, according to the US Preventive Services Task Force, an independent panel of medical experts who recommend screenings and services to keep Americans healthy.
These scans, which are covered by insurance for people who meet the USPSTF screening requirements, use far less radiation than conventional CT scans and have been shown to be able to detect early lung cancers, as well as other conditions, according to medical experts.
Some doctors say they recommend screening using the American Cancer Society’s guidelines, which are slightly different and do not guarantee full insurance coverage. The influential group says anyone aged 50 to 80 with a history of heavy smoking, regardless of when you might have quit, should be screened annually.
“When lung cancers are detected early through lung cancer screening, they are highly curable,” said John Heymach, chair of thoracic/head and neck medical oncology at MD Anderson Cancer Centre in Texas. “In all the studies, we see cure rates above 90%.”
Lung cancer can also be caught at earlier stages in people who get CT scans for unrelated reasons. But experts say many people who don’t meet the screening guidelines are often diagnosed with advanced disease because the cancer isn’t found until they’re showing symptoms.
“Waiting for symptoms leads to most patients having a Stage 4 diagnosis,” said Narjust Florez, a thoracic medical oncologist and co-director of the Young Lung Cancer Programme at the Dana-Farber Cancer Institute in Boston.
By the time Creel got a CT scan, the cancer had spread to her brain, bones and lymph nodes.
“I had known it was definitely outside my lungs,” she said. “Did I expect it to be everywhere that it was? Absolutely not.”
What needs to change?
Official recommendations for lung cancer screening take into account smoking habits, but smoking rates have decreased, Heymach said. Meanwhile, he and other experts say they’re seeing more cases of lung cancer in non-smokers or people who haven’t smoked for at least 15 years.
“The population we’re screening is a smaller and smaller percentage of the whole lung cancer population,” he added. “Low-dose screening CT works, but we’re just not screening enough people.
”The findings in the latest study are “really shocking”, said Heymach, who was not involved in the research.
“It shows that if we kept the current guidelines, we would only catch about one-third of new lung cancers.”
The research suggests that switching to universal age-based screening could save thousands of lives each year – an estimate greater than the number of people who die of brain cancer, Heymach said.
“Imagine if we said that implementing this screening would be like eradicating a whole disease like brain cancer,” he said. “Who wouldn’t think that’s a worthwhile thing to do?”
Changing screening guidelines could also be a cost-effective move, Bharat said. The study found that if age-based screening caught 30% of cases at stage one, it would help save nearly $25bn annually in treatment costs, an amount much greater than the price of broadening access to scans.
Since her diagnosis, Creel has undergone multiple rounds of chemotherapy and a surgery that resulted in the removal of the right upper lobe of her lung. She is also on a prescription medicine used to treat non-small cell lung cancer.
How to lower that risk
People who are eligible should talk to their doctors and schedule a scan. Lung cancer screening rates among people who should be getting tested are low, said Alexis Chidi, a thoracic surgeon and co-director of the Lung Cancer Screening Programme at Memorial Sloan Kettering Cancer Centre.
State-level data suggest between 9% and about 30% of eligible people get screened, one recent study found.
“In addition to making sure that we’re expanding screening criteria, I think a really important part of this is making sure people are getting to screening and that we eliminate the barriers, which are not just based on the guidelines,” Chidi said.
In many cases, she noted, people who are eligible see their healthcare providers every year and never have a discussion about screening. For others, worries about costs, transportation, or time away from work can make the screening process more challenging.
It’s also important to increase screening for people who are at the highest risk, she said.
Among people who are not eligible to be screened, experts say, those worried about their lung cancer risk aren’t left with many options.
Conventional CT scans are available – and they are expensive out of pocket and usually require a physician to sign off.
See more from MedicalBrief archives:
Updated US guidelines urge more lung cancer screening
UK offers free lung screening for ex-smokers in early detection drive
Late diagnosis by GPs link to lung cancer mortality — UK report
CT scan catches 70% of lung cancers at early stage — SUMMIT study