Opinion | Dr. Lena Wen: Increased lung cancer screenings

Opinion |  Dr. Lena Wen: Increased lung cancer screenings

Lung cancer kills more than 130,000 Americans annually, more than any other cancer. But this number should not be too high. Health officials can significantly reduce the disease’s toll simply by increasing testing for it.

About 1 in 4 cases of lung cancer are diagnosed in the early stages. Why? The main reason is that the screening rate is very low. According to a report released last year by the American Lung Association, less than 6 percent of eligible Americans receive low-dose CT scans annually. In some states, screening rates are as high as 1 percent.

Updated guidelines from the American Cancer Society (ACS) seek to increase the number of people eligible for such screenings. Hospitals, insurance companies, and primary care providers should not delay in implementing these recommendations.

It is known that the main risk factor for lung cancer is cigarette smoking, which is associated with 80 to 90 percent of lung cancer deaths. The amount and duration of smoking is reflected in “pack years,” or the number of packs consumed per day multiplied by the number of years a person has smoked. The risk of cancer increases with age as well as age. It decreases in those who have quit smoking.

The ACS previously recommended annual screenings for people ages 55 to 74 with a smoking history of at least 30 years and who quit smoking less than 15 years ago. The new guidelines made several key changes, including expanding the age criteria to between 50 and 80 years, lowering smoking history to 20 years, and eliminating the “years since quitting” measure. (There are not enough data for people over 80 years of age, who are advised to discuss their health condition and the benefits of continued screening with their doctors.)

The decision is rooted in careful analysis of new research. Using old eligibility criteria, a large randomized trial published in 2011 found that those who received regular screenings had a 20% lower lung cancer death rate than those who did not. But a 2020 study, also published in the New England Journal of Medicine, found that by including people ages 50 to 54 and lowering the minimum pack years to 15, the mortality reduction rose to 24 percent among men and 33 percent. percent among women.

The study also shows that expanding eligibility can help alleviate disparities. Research has shown that Black Americans have a lower history of childbearing years than white Americans and are more likely to be diagnosed with lung cancer before the age of 55. Women also report dating for fewer years than men. Thus, increasing the pool of people at high risk would have a huge impact on women and minorities who qualify for testing.

This new eligibility is consistent with several other major organizations, including the U.S. Preventive Services Task Force, which also recommends starting screening at age 50 for those with a 20-year history. However, the task force does not recommend screenings for people who resigned more than 15 years ago.

However, eliminating this last criterion could have a greater impact than changes in age or packing year recommendations. Health officials have long believed that former smokers’ risk of developing cancer decreases over time. But while it is true that the chance of developing lung cancer decreases after you stop smoking, the risk remains significantly high. After 15 years of quitting smoking, the risk is up to 10 times greater than in people who have never smoked. Even after 30 years, the risk of dying from lung cancer remained three to four times higher.

Age also plays a role. In a pivotal study published this month in the journal Cancer, researchers found that although there is a reduction in the risk of aging in the first five years after quitting smoking, the decline slows, and after 10 years of stopping, the increased risk of aging outweighs the effect. Of quitting smoking. They estimated that removing the “years since quitting” criterion would make 4.9 million additional people eligible for screening and save 8,275 additional lives each year.

This change alone could significantly increase screening. Individuals who have already taken annual tests will be encouraged to continue with them, rather than stopping 15 years after quitting smoking.

Moreover, the new recommendations are clearer. It does not matter whether the person is a current or former smoker; If their pack is over 20 years old and between 50 and 80 years old, they need to be examined. People who smoked heavily in their teens but stopped smoking many years ago may not consider themselves at risk for lung cancer, but they now qualify and should get a low-dose CT scan annually.

Remarkably, as of 2021, more than 75 percent of women ages 50 to 74 have had a mammogram within the past two years. About 72% of people in the same age group received colorectal cancer screening according to national guidelines. The new ACS guidelines should trigger a national awareness campaign to incentivize lung cancer screenings. As with other types of cancer, early diagnosis and prompt treatment are key to saving lives.

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