Catching a Killer: Millions are missing out on lung cancer screening

In the spring of 2022, Marcy Duncan was still in the process of healing from surgery for stage I breast cancer when she had a life-altering conversation with her oncologist. Anticipating discussions about radiation and future treatment steps, she and her boyfriend met with her doctor. However, the doctor shifted the focus to a more pressing concern, leaning closer to the couple.

The specifics of the conversation are somewhat blurred in Marcy’s memory. Did he mention the discovery of a mass, or was there talk of lung cancer? She distinctly recalls hearing the size – 8 centimeters, but her mental image conjured something far larger. It was an overwhelming moment of shock and disbelief.

This unexpected twist of fate highlights a fundamental issue: the lack of regular lung cancer screenings, as recommended by the U.S. Preventive Services Task Force. They recommend yearly low-dose computed tomography (CT) screenings for older adults who smoke or have a history of smoking. This recommendation has been in place for a decade, with more than 14 million eligible adults in the United States. However, in 2021, only 5.8% of them received these screenings, according to data from the American Lung Association.

The result is that lung cancers like Marcy Duncan’s are often discovered almost by chance rather than through routine screening. Lung cancer is the leading cause of cancer-related deaths in the United States, claiming approximately 127,000 lives each year. Alarmingly, it is frequently diagnosed at an advanced stage, significantly reducing survival rates.

Marcy’s father was a tragic example of late diagnosis, as his lung cancer was discovered when it had already grown to the size of a grapefruit. Recognizing Marcy’s family history and her own history of smoking, her oncologist urged her to undergo a lung scan. Yet, only one in five lung cancers are detected before they spread to the lymph nodes or beyond, despite advancements in treatment. In its early stages, lung cancer is more treatable and carries a better prognosis.

Ironically, despite the heightened risk and the potential benefits of early detection, a significantly lower percentage of eligible adults undergo lung cancer screening compared to screenings for other types of cancer, such as mammography and colonoscopy. The reasons for this disparity are multifaceted, involving complex guidelines, geographic accessibility, and public perception of the potential benefits.

Lung Cancer Screenings: A Complex Issue

Screening for lung cancer involves a more intricate set of criteria compared to breast or colon cancer screening, which primarily relies on age. Some individuals may live far from screening programs, making it difficult to access these vital screenings. Furthermore, not everyone fully comprehends the life-saving potential of these tests.

When lung cancer is detected in its early stages, patients have an 80% chance of surviving for at least 20 years, as reported by researchers. However, the public perception of lung cancer often skews toward a fatalistic perspective. Some individuals may question the value of seeking out a disease that they believe will inevitably lead to a fatal outcome, and this pessimistic view can deter them from pursuing screening.

Timothy Mullett, MD, a lung cancer surgeon at the University of Kentucky, co-leads an initiative aimed at enhancing prevention and early detection of lung cancer. He emphasizes the perception some smokers and former smokers have, involving guilt and self-blame for causing their own tobacco-related health issues. He underscores that addiction is a complex and powerful force, and the idea that they somehow “deserve” their condition is unjust and incorrect.

Promising Future Technologies

In addition to the traditional annual chest scans, emerging technologies and approaches may play a crucial role in improving early detection and treatment of lung cancer. Liquid biopsies, advanced blood tests that can detect tumor DNA and other cancer markers, are under development and hold promise for non-invasive cancer detection. Furthermore, artificial intelligence (AI) is being harnessed to analyze vast databases of CT scans to identify individuals at higher risk for lung cancer.

Jacob Sands, MD, a lung cancer physician at the Dana-Farber Cancer Institute, emphasizes that for the time being, annual chest scans remain the most effective method to detect early-stage lung cancer in smokers and former smokers. These scans are quick and painless, with no discomfort for the patients. It involves lying on a table for a brief CT scan, typically taking only a few minutes. According to Sands, this simple screening can significantly increase the likelihood of curing lung cancer when detected early.

Missed Opportunities

Marcy Duncan’s story is an example of how sometimes, one medical condition can lead to the discovery of another. While healing from breast cancer surgery, she decided to pursue a lung scan, as her doctor had recommended. This decision, despite her initial reluctance, turned out to be life-saving.

While Marcy had been a smoker for decades, she didn’t exhibit typical symptoms of lung cancer, such as a smoker’s cough or shortness of breath. However, her proactive approach paid off. Her lung cancer was detected before symptoms surfaced, and she underwent chemotherapy, radiation, and immunotherapy. Although it’s too early to declare remission, she is currently in good health and sees the importance of early screening. Her sister, upon her recommendation, also underwent a lung scan that yielded a cancer-free result. Marcy passionately encourages anyone who qualifies for screening not to delay it. She emphasizes that self-blame and guilt about smoking should not deter individuals from getting screened, as the knowledge gained from screening is far more valuable than the anxiety of not knowing.

Addressing the Needs of Nonsmokers

While lung cancer screening is primarily recommended for individuals with a history of smoking, the U.S. Preventive Services Task Force does not advise lung cancer screening for those who have never smoked. However, there are exceptions for nonsmokers at high risk, based on individual factors such as a strong family history of lung cancer, specific genetic mutations, or environmental exposures. Yet, these exceptions do not apply to the general population.

As the battle against lung cancer continues, the imperative for early detection and proactive screening is clear. Increased public awareness, improved accessibility, and advancing technologies are central to improving lung cancer outcomes for all individuals, whether or not they have a history of smoking.