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

New guidelines recommend starting annual scans at age 50, including for people who quit more than 15 years ago


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Even if you haven’t touched a cigarette in decades, you could be due for an annual lung cancer screening, based on new recommendations from the American Cancer Society (ACS).

In its updated guidelines, the group says that adults ages 50 to 80 who currently smoke or used to smoke the equivalent of one pack a day for 20 years should get an annual low-dose computed tomography scan (also called a CT scan), no matter how long ago they quit. 

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The new criteria, published in the journal CA: A Cancer Journal for Clinicians, extend screening recommendations to about 5 million more adults. Previous ACS guidelines said that people no longer needed the annual cancer screening if it had been 15 years since they quit, and it was only recommended for current or former smokers between the ages of 55 to 74 who smoked the equivalent of one pack a day for 30-plus years.

Robert Smith, lead author on the guidelines and senior vice president of early cancer detection science at the cancer society, explained in a news release that the change is based on new studies that “have shown extending the screening age for persons who smoke and formerly smoked, eliminating the ‘years since quitting’ requirement and lowering the pack per year recommendation could make a real difference in saving lives.”

Broadening the eligibility criteria will also help to “include more women and minorities, who typically smoke fewer cigarettes daily,” says Maher Karam-Hage, M.D., professor of behavioral science at the University of Texas MD Anderson Cancer Center. “Reducing the age and pack-year requirements allows them to qualify sooner, potentially leading to earlier detection of any suspicious nodules or masses,” he told AARP in an email.

Pack-year is a measure used to describe how many cigarettes a person smoked and for how long. For example, a person would have a 20 pack-year history if they smoked one pack a day for 20 years, or two packs a day for 10 years.  

Early detection is key to saving lives

Warning Signs of Lung Cancer

Many people don’t experience symptoms until the cancer is advanced. Symptoms may include:  

  • Coughing that gets worse or doesn’t go away.
  • Chest pain.
  • Shortness of breath.
  • Wheezing.
  • Coughing up blood.
  • Fatigue.
  • Weight loss with no known cause.
  • Repeated bouts of pneumonia.
  • Swollen or enlarged lymph nodes inside the chest in the area between the lungs.

Source: CDC

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.

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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.  

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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.

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