Annual CT Scans Urged For Smokers At Risk For Lung Cancer

An influential government panel recommends that millions of smokers and ex-smokers at high-risk of developing lung cancer get annual CT scans to determine if they have early signs of the disease.

The U.S. Preventive Services Task Force released draft recommendations that will likely be approved, experts say, paving the way for insurers to pay for such screening. Currently, most patients must pay out-of-pocket for the scans, which cost about $300-$400. The full set of recommendations was published today in the Annals of Internal Medicine. The bottom line: "Strong evidence shows that [low-dose] CT screening can reduce lung cancer and all-cause mortality."

Lung cancer is the leading cause of cancer-related death in the United States, and "because early-stage lung cancer is associated with lower mortality than late-stage disease, early detection and treatment may be beneficial," the report said. But such early detection and treatment has been elusive, according to experts.

In making the new recommendations, the 16-member government panel said that screening should target older patients at highest risk:

After reviewing the evidence, the Task Force determined that you can reach a reasonable balance of benefits and harms by screening people who are 55 to 80 years old and have a 30-pack-year or greater history of smoking, who are either current smokers or have quit in the past fifteen years. A “pack year” means that someone has smoked an average of one pack of cigarettes per day for a year. For example, a person reaches 30 pack years of smoking history by smoking a pack a day for 30 years or two packs a day for 15 years.

NPR's Richard Knox reports that the panel's new proposal, based on a government financed study of more than 50,000 people published two years ago, remains controversial:

It's a change that some won't welcome. Some experts warn that it's going to cause too much follow-up testing for many patients, with the accompanying anxiety. Another concern is that screening will uncover many cancers that would never have caused a problem – a phenomenon called overdiagnosis...

The task force estimates that its proposed recommendation will cut U.S. lung cancer deaths by 20,000 a year. That's only about 13 percent of the nearly 160,000 people who die of the disease in this country annually.

"That's a relatively small proportion of those 160,000 deaths," [task force vice chairman] LeFevre acknowledges. The problem is that even with screening, many people's lung cancer will be too advanced for effective treatment. "But a small proportion of a big number is still a big number," adds LeFevre. "And 20,000 lives is a lot of people."

He says the lung cancer screening test – a computed tomography or CT scan – is actually more effective than mammography or colonoscopy in saving lives.

Dr. Christopher Lathan, M.D., a medical onologist at the Dana-Farber Cancer Institute and director of its cancer care equity program, says the new recommendations are "a long time coming."

Even though lung cancer kills more people in the U.S. then breast, prostate and colon cancer combined, Lathan said, "we haven't had a screening modality for it. And unfortunately once you have symptoms, it's too late to cure. This is a great opportunity to treat people."

He adds that there remains a stigma around lung cancer — everyone asumes you're a smoker or ex-smoker and somehow responsible for your illness — that doesn't happen with other cancers. "This stigma is very damaging," he said. "It's damaging for patients which makes it hard for them to get support and it has damaged the conversation on screening. The conversation in lung cancer has been all about prevention — and we need to focus there. But we also need to help people at risk."

Indeed, lung cancer screening programs do exist, but they're generally not covered by insurance. "It's ironic that those facing the highest risk were least able to pay," Lathan said. "These recommendations are a big step in leveling the playing field."

For more on the implications of screening for lung cancer see our earlier post here.