Millions More Smokers Need Lung Cancer Screening, Even Decades After Quitting

Early detection is key to saving lives

Lung cancer is the deadliest cancer in the U.S., according to the National Cancer Institute. An estimated 238,340 new cases are expected to be diagnosed in 2023, and about 127,070 Americans will die from the disease.

The cancer can occur in anyone at any age; however, cigarette smoking is the top risk factor and is linked to about 80 to 90 percent of lung cancer deaths, and most people diagnosed with the disease are age 65 or older.

What makes lung cancer especially tricky is that it’s often symptomless until it’s at an advanced stage, when it’s harder to treat. Karam-Hage says that in large-scale trials, early detection can lead to a 20 to 25 percent improvement in survival rates, resulting in fewer deaths from lung cancer.

But a 2022 report from the American Lung Association found that only 5.8 percent of people eligible for lung cancer screening in the U.S. get screened; the screening rate is as low as 1 percent in some states.

The American Cancer Society’s Smith says that while lung cancer cases and deaths continue to drop due to fewer people smoking and advances in treatment, “we still have to do better,” and that the update in the guidelines “is a step in the right direction.” About 19 million Americans would benefit from an annual lung cancer screening, based on the latest recommendations.

Eligible? Talk to your doctor

If you now fall into the population eligible for a lung cancer screening based on these new recommendations, start by speaking with your primary care physician, Karam-Hage says — even if it’s been a long time since you smoked.

“Traditionally, it was believed that after 15 years of no-smoking, the risk of lung cancer decreases to a point that screening is no longer cost effective. However, new data suggests that while the risk of lung cancer in former smokers goes down, the risk of malignancies from aging increases,” Karam-Hage says.  

The updated ACS guidelines fall closer in line with those from the U.S. Preventive Services Task Force, which often influence insurance coverage, but they still differ on the years-since-quitting requirement. The task force’s current guidelines, issued in 2021, say adults ages 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should be screened for lung cancer.  

Medicare Part B will cover lung cancer screenings with a low-dose CT scan once a year for people ages 50 to 77 who are current smokers or quit in the last 15 years and have a 20-pack-year history. Patients must have an order from their doctor or health care provider and should not have symptoms of lung cancer. People with private insurance should check with their plan provider about coverage eligibility and potential out-of-pocket costs.

A low-dose CT scan is a noninvasive test where you lie down and hold your breath while being moved through a doughnut-shaped X-ray machine, according to the Centers for Disease Control and Prevention. The scan takes several X-ray images of the lungs and can help to identify possible abnormalities in the lung tissue.

There are some potential risks with this screening, including the possibility of false positives, which can lead to more scans or invasive procedures, Karam-Hage says. According to the American Lung Association about 12 to 14 percent of lung cancer screening scans will have a false positive, about the same rate as with mammograms.

“It’s essential to weigh these risks against the benefits, and in my opinion the advantages outweigh potential drawbacks,” Karam-Hage says.