Who Should Be Screened for Lung Cancer Under New American Cancer Society Guidance

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Prapass Pulsub / Getty Images

Fact checked by Nick Blackmer

Key Takeaways

  • The American Cancer Society has released updated lung cancer screening guidelines.

  • The guidance was last updated in 2013.

  • The new recommendations expand screening to more people.

The American Cancer Society (ACS) has released new lung cancer screening guidelines. Screening guidance from the organization was last updated a decade ago.

A primary goal of the new guidelines is to start screening sooner and keep screening longer.

“This updated guideline continues a trend of expanding eligibility for lung cancer screening in a way that will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early,” Robert Smith, PhD, senior vice president of early cancer detection science at the American Cancer Society and lead author of the new lung cancer screening guideline report, said in a statement.

The new screening guidelines are slightly different from the 2013 recommendations. Here’s how, plus what lung cancer experts think.

What Are the New Screening Guidelines?

The new screening guidelines recommend that people aged 50 to 80 with a 20 or more pack-year history be screened each year for lung cancer.

“Pack year is the number of cigarettes smoked daily multiplied by the duration of smoking in years,” Rohit Kumar, MD, director of respiratory and pulmonary function service and associate professor at Fox Chase Cancer Center in the Temple University Health System, told Verywell. For example, having 20 cigarettes a day (or a pack) for 20 years would be 20 pack years.

The guidance also recommends that people who are eligible consult with their doctor about potential benefits, limits, and harms of yearly screening. It also suggests that people who still smoke should receive counseling to help them quit.

Related: 10 Things That Happen When You Quit Smoking

The ACS’s new guidance is slightly different from their 2013 recommendation. Those guidelines said that people aged 55 to 74 with a 30 or more pack-year history should be screened yearly for up to 15 years after they quit smoking. The latest recommendations expanded the age range, lowered the pack-year history, and removed the suggestion on when to stop screening.

It’s important to point out that the United States Preventive Services Task Force (USPSTF) issued similar recommendations in 2021. The only difference between the USPSTF recommendations and the new ACS recommendation is how long testing is recommended for: The USPSTF still states that screening should be stopped after it’s been 15 years since someone quit smoking; the ACS has no time limit on how long someone should do testing.

Still, screening beyond 15 years is a “significant departure from the USPSTF,” Sara Belton, PhD, RN, a nurse navigator for Providence Saint John’s Health Center’s Lung Screening Program, told Verywell.

“The ACS further states that clinicians and patients should work together to decide for how long patients should have annual lung cancer screening,” she said. “This respects the fact that patients will have different health and illness experiences, and that their cancer screening should be reflective of their own situation and clinical needs, decided jointly with the expertise of their health care provider.”

Related: Lung Cancer Survival Rates by Type and Stage

What Is Lung Cancer Screening Like?

Screening is conducted with a low-dose computed tomography scan (also called a low-dose CT scan, or LDCT).

“This is a highly effective method for early detection of lung nodules or cancer,” Maher Karam-Hage, MD, professor of behavioral science at the University of Texas MD Anderson Cancer Center, told Verywell. “This non-invasive imaging technique helps identify potential abnormalities within the lung tissue, allowing for prompt medical evaluation and intervention when necessary.”

The screening test is a “very simple, quick, painless procedure,” Lary Robinson, MD, thoracic surgeon at Moffitt Cancer Center, told Verywell. “The person lies down on the bed in the CT scanner. The scan takes less than a minute—usually it’s a single breath-hold—and it does not involve any contrast media (a chemical injected into the body to help images appear).”

Removing the time frame around when a patient stopped smoking and expanding the age recommendation for screening is expected to help detect more cancers, Belton said.

How Expanded Screening Will Make a Difference

“I have seen situations where patients have developed lung cancer past the 15-year post-smoking cutoff mark for lung cancer screening,” she said. “While this cutoff has been part of the USPSTF guidelines for years, it may be more a reflection of the lack of data and research on lung cancer risk for older ex-smokers who are past the 15-year cutoff mark. There simply haven’t been many or even any studies on this, and a lack of data does not mean there isn’t need for continued cancer screening as people age.”

Expanding the qualifications for screenings also raises the odds a person’s lung cancer will be detected sooner, Dr. Kumar said. When this happens, “outcomes are much, much better,” he said. “Early stage lung cancer has a more than 80% survival vs. less than 50% for later stages.”

Will Insurance Cover This?

It’s unclear whether the people who fall under the ACS’s new recommended criteria for screening will actually be able to get that scan covered by insurance.

“At present, the USPSTF guidelines for lung cancer screening are followed by insurance companies and Medicare,” Robinson said. “They cover the cost of the low-dose screening CT scan only for current smokers or those that have stopped smoking in the last 15 years.”

Robinson said he’s hopeful that USPSTF will also modify its screening guidelines to remove the 15-year requirement.

What This Means For You

If you have a history of smoking, you may be eligible for lung cancer screening at an earlier age and for a longer period of time under the new ACS guidelines. Talk to your healthcare provider about your personal risk of lung cancer, as well as what screening choices may be right for you.

Read the original article on Verywell Health.