Lung Cancer Awareness Month: 7 Reasons Screening is Underused
Lung cancer is by far the deadliest cancer, representing nearly a quarter of all cancer deaths. However, there is good news: The incidence of lung cancer and death rates are decreasing every year in the United States, largely because the number of adults who use tobacco continues to decrease.
Still, this progress is not distributed equally among populations. About 22% of patients who are uninsured or on Medicaid smoke. In addition, between 20% and 30% of patients with a GED degree or without a high school diploma smoke. Studies have shown a higher number of tobacco advertisements in African American neighborhoods than in other areas. Therefore, more work is needed, especially to help young adults in these at-risk populations.
One of the reasons that lung cancer remains so deadly is that patients typically do not have symptoms until the disease has spread throughout the body. That is why lung cancer screening with low-dose computed tomography, or LDCT, is a vital tool to detect lung cancer early so it can be treated and cured.
Nonetheless, lung cancer screening remains underused: About 77% of women undergo screening for breast cancer, whereas only about 7% of those who are eligible for lung cancer screening receive it.
For Lung Cancer Awareness Month this November, we talked with University of Florida Health experts about the reasons and what patients need to know about lung cancer screening.
Patients are unaware of the benefits of lung cancer screening
In 2021, the U.S. Preventive Services Task Force expanded the pool of people eligible for lung cancer screening. It recommends annual screening with LDCT for adults who meet all of the following criteria:
- 50 to 80 years old
- At least a 20 pack-year smoking history, which means one pack a day for 20 years (or two packs a day for 10 years and so on)
- Current smoker or quit smoking within the past 15 years
The multicenter National Lung Screening Trial, sponsored by the National Cancer Institute, found that for those at highest risk, three rounds of lung cancer screening was associated with a 20% reduction in lung cancer-related death compared with chest radiography. Medicare and Medicaid cover this annual screening for patients who meet the criteria above.
“There is a substantial benefit of lung cancer screening,” said Hiren Mehta, MD, a professor of medicinein the division of pulmonary medicine within the UF College of Medicine. “The way lung cancer screening improves survival is by catching cancer at a much earlier stage, way before it starts spreading. We see that every day in our practice: We pick up small cancers much earlier that we can get rid of before they spread and ultimately affect patient mortality.”
UF Health offers a comprehensive lung cancer screening program. Patients receive high-quality cancer care from a multidisciplinary team of pulmonologists, radiologists, primary care physicians, thoracic surgeons, thoracic oncologists and nurse navigators. In addition, 9 out of 10 lung cancer referrals are seen within seven days. That access to care is key to starting treatment early and giving patients the best chance at a cure.
Patients face financial or logistical hurdles
Patients may be deterred from lung cancer screening by a lack of access to primary care providers. A lack of insurance or inability to pay possible out-of-pocket costs could also be hurdles.
Many patients who are screened for lung cancer have other types of lung disease such as chronic obstructive pulmonary disease, or COPD, meaning screening picks up abnormalities. These may require follow-up scans, presenting additional obstacles.
Inaccurate information on the risks of smoking persist
It’s important to have the facts on the risks of smoking. For example, some still cite an outdated statistic that only 10% of smokers get lung cancer.
“This may encourage smokers to takeaperceived 1 in 10 chance,” said Frederic Kaye, MD, a professor in the division of hematology and oncology within the UF College of Medicine. “In fact, data over the past decades shows that 20% to 25% of patients who continue to smoke at least one pack per day will have a diagnosis of lung cancer by age 75. This represents a 1 in 5 to 1in 4 chance of getting lung cancer.”
Patients may also believe that if they have already smoked for years, they won’t benefit from quitting. Data show that the earlier patients quit smoking, the greater their reduction in lung cancer risk, but the risk of lung cancer still declines for patients who quit smoking later in life.
“There is still a benefit in quitting now, and I definitely see that in my practice,” said Kaye, who is also co-medical director of the thoracic oncology program.
Lung cancer carries stigma, mainly because of its connection to smoking
Unlike some other types of cancer, lung cancer can be associated with guilt.
“Patients sometimes feel like they did this to themselves, which can make them reluctant to get screened,” Mehta said.
Some patients also express concerns that getting screened for lung cancer will open up a can of worms, snowballing into more tests and procedures they have to undergo.
“At UF Health, we have a very comprehensive, multidisciplinary program where we thoroughly discuss every patient’s case, and we make sure patients get the individualized care they need,” Mehta said.
Communication on the risks of lung cancer screening can cause unneeded fear
Discussions between primary care providers and patients about the risks of lung cancer screening, which are required by the Centers for Medicare and Medicaid Services, can make patients afraid that they will undergo unnecessary invasive procedures or be exposed to harmful radiation.
It’s true that lung cancer screening, like all types of cancer screening, has a risk of false positive findings. However, at UF Health, all patients are discussed in a multidisciplinary setting to maximize benefits and reduce harms of lung cancer screening.
In the National Lung Screening Trial, false positives led to invasive procedures, such as a biopsy, in less than 3% of patients screened, and complications occurred in just 0.1% of patients screened. For every 1,000 patients screened, false positives led to 17 invasive procedures and less than one person having a major complication.
Lung cancer screening is conducted in high-risk patients
The benefits of lung cancer screening in terms of how many patients need to be screened to save one life are more favorable for lung cancer screening than for other types of cancer screening, such as mammography screening for breast cancer.
“This is mostly because lung cancer screening is done only in high-risk patients, those who have smoked heavily, whereas all women over a certain age are recommended to get mammography screening,” Kaye said.
Eligible patients may not be regularly involved in the health care system.
Underserved patients may feel a lack of trust with the medical system
Trust with medical professionals can be a barrier, particularly for underserved populations.
The new guidelines should improve access and equity in lung cancer screening, said Dejana Braithwaite, PhD, associate director for population sciences at the UF Health Cancer Center and a professor of surgery and epidemiology in the UF College of Medicine and College of Public Health and Health Professions. She noted that a recent study showed that the new U.S. Preventive Services Task Force criteria are expected to increase eligibility for Black, Hispanic, American Indian and Alaska Native populations compared with white and Asian populations.
At UF Health, physicians are committed to understanding each patient’s concerns about lung cancer screening and ensure they receive the care they need.
“My biggest piece of advice is that lung cancer screening saves lives,” Mehta said. “The way it saves lives is by picking up the cancer before it spreads, which helps us treat it and cure it as opposed to just controlling it.”