Lung cancer can grow silently for years before symptoms appear, making early detection critical for survival. Yet many Americans who qualify for screening never receive it, according to cancer specialists who say the gap translates to tens of thousands of preventable deaths each year.
Dr. Daniel J. Boffa, chair of the American College of Surgeons Commission on Cancer and a thoracic surgeon at Yale University, said lung cancer screening is «one of the most powerful ways» to improve survival. «It reduces the chance of people dying of lung cancer by 20%,» he said, adding that the share of eligible Americans who skip screening represents a major public health failure.
Current guidelines from the American Cancer Society recommend an annual low-dose CT scan for people aged 50 to 80 who currently smoke or have a history of smoking, or who have at least a 20 pack-year smoking history. A pack-year is calculated by multiplying the number of packs smoked per day by the number of years smoked. The scan takes only a couple of minutes and does not involve the enclosed space of an MRI, making it tolerable for people who experience claustrophobia.
Dr. Lary Robinson, an oncologist at Moffitt Cancer Center in Tampa, Florida, noted that early-stage lung cancer usually produces no symptoms. When symptoms do appear, they often include a persistent cough, shortness of breath or coughing up blood. Unexplained weight loss and persistent headaches may also warrant a doctor's visit.
Despite the clear benefits for high-risk smokers and former smokers, there is no established screening guideline for people who have never smoked, even though about one in seven lung cancers occurs in never-smokers. Boffa called finding never-smokers who would benefit from screening an «intense area of research.» For now, he said people with a direct family history of lung cancer who never smoked should consider annual screening, as should higher-risk groups such as Asian women.
«I would anticipate that in the next year or two, we will have better guidance for people who are at risk for lung cancer, but never smoked,» Boffa said. He also predicted that within four or five years, a screening CT scan may become a confirmatory step after a positive blood test performed at a doctor's office, potentially making screening more accessible.
Boffa stressed that screening should not be viewed as a pathway to a terminal diagnosis. Advances in treatment have improved survival even at advanced stages, he said, and the stigma surrounding lung cancer has made some people reluctant to be screened. «For years, there was a reputation that it was a terminal diagnosis,» he said. «It's just been amazing what research has done for lung cancer.»
Most screenings detect a lung nodule or other abnormality, which is more often an infection, scar or inflammation than a tumor. In about one-third of patients, screenings also uncover unrelated health issues, including hardening of the heart arteries or a nodule elsewhere in the body. «The reality is over 99% of nodules are actually benign,» Boffa said. «And so, you need to have a conversation about what you are going to do with that information.»
The American Cancer Society advises people considering screening to discuss its purpose, benefits, limits and possible harms with their healthcare providers. Those who still smoke should be counseled about quitting and offered resources to help. Individuals with serious health problems likely to limit their lifespan, or who would not be able to receive treatment if cancer were detected, should not be screened.
For people over 50 with a history of smoking, Boffa reiterated that getting screened is «one of the most powerful things you can do to reduce your chances of having your life shortened by lung cancer.»