Are Current Lung Cancer Screening Guidelines Missing Early Detection?

One of the most frustrating aspects of the battle against lung cancer is that the disease is relatively easy to treat – and even cure – if detected in its earliest stages. Unfortunately, our current detection strategies are falling short.

That’s one of the reasons the disease is the leading cause of cancer deaths in the U.S. for both men and women. It claims more lives than colon cancer, prostate cancer and breast cancer combined – despite the fact that far more people are diagnosed with those three cancers each year.

Among the factors driving the disparity is way we handle screenings for these diseases.

Current Age-Based Screening Guidelines for Common Cancers

During the last two decades, we have made significant strides in reducing cancer deaths. The five-year survival rate for patients whose cancer was found in early stages has increased to 70 percent from 63 percent in the mid-1990s, according to the American Cancer Society.

At least part of the credit for that improvement goes to an array of screening protocols used for the most common cancers. Most of the screening guidelines are based on your age, as developed by the U.S. Preventive Services Task Force, which plays a key role in determining what services insurers will cover. Among the common screening guidelines:

• Breast Cancer: The task force recommends mammograms every other year for all women, starting at age 40. This continues through age 74.

• Colon Cancer: It is recommended that regular screenings for everyone start at age 45, with follow-up screenings every five or ten years. This interval assumes you are getting a colonoscopy, and may be shorter if you choose other, less-effective, screening options.

• Prostate Cancer: Screening is recommended to start at age 55 for all men and continue until age 69.

How Lung Cancer Screening Criteria Differs (The 20 Pack-Year Rule)

With lung cancer, there is a significant difference in the screening strategy. The task force recommends annual screening by CT scan for anyone between the ages of 50 and 80, with a history of heavy smoking – defined as at least 20 pack-years. So, instead of a simple age-based formula, there is the need to factor in smoking history.

That can be a little tricky, starting with the definition of a pack year – which is smoking an average of one pack of cigarettes each day for a year. If you smoked a pack a day, you would hit the screening trigger after 20 years. But if you smoked two packs a day, it would take only 10 years to hit the threshold.

If you don’t feel like doing the math, the American Lung Association offers an online quiz that can help you determine if you should be screened under current guidelines.

The criteria create a fairly narrow window of people who are eligible for screenings that will be covered by insurance. Notably, the guidelines exclude anyone who has not smoked within the last 15 years.

These guidelines have certainly helped find cancer cases early. The disease, after all, is notorious for its ability to grow quietly in your body. Often, by the time the first symptoms appear, cancer has already spread beyond its easier treatment stages.

The problem is that the guidelines are still missing many cancer cases. One recent study, for example, examined 1,000 consecutive lung cancer patients. Only 35 percent of those patients would have qualified for screening under the current guidelines.

The Case for Age-Based Lung Cancer Screenings

In an ideal world, lung cancer screenings would be treated with strict age-based criteria similar to what’s used for those other cancers. Doing so could significantly expand our ability to catch lung cancer early. It would also catch the disease in casual smokers and those who were exposed to second-hand smoke.

This would substantially increase overall screening expenses for insurers. But that would be more than offset by lower treatment costs, since early-stage diseases are less costly to treat. We spend much more money on chemotherapy, immunotherapy and radiation while treating late-stage cancers than we do for the surgery and radiation treatment used in early-stage cancers.

There is also hope that researchers will develop other screening tools. Colon cancer, for example, has tests that look for certain biomarkers in feces that could indicate colon cancer. Work is underway on similar tests for lung cancer, though none of them have yet proven effective enough.

Out-of-Pocket CT Scan Options for High-Risk Patients

As things stand, you do still have options. There are imaging facilities that offer CT scans, even if your insurance won’t cover the cost. These scans cost about $250. If you are a current or former smoker who doesn’t meet the screening criteria, it may be worth the cost for your peace of mind.

This content is not AI generated.