Screening for lung cancer using thin-slice computed tomography (CT scans) in people at increased risk for lung cancer was shown almost twenty years ago to reduce dramatically mortality from lung cancer, an otherwise lethal disease. Asymptomatic at-risk people who were diagnosed with early-stage lung cancer has an almost 90% rate of survival. So who is at risk? The original definition was people between 55 and 80 years old with 30 pack-years of smoking. Those numbers were changed in 2021 to 20 pack-years and ages 50-80. So as a society, how are we doing with compliance?
By comparison, over 75% of women over 50 have had a mammogram within the last two years, and 72% of people over 50 have has some form of colorectal cancer screening (either colonoscopy, or sigmoidoscopy plus a stool test typically). The authors of a recent study in JAMA Internal Medicine did a statistical analysis of compliance with lung cancer screening in the United States in the last several years. Dr. Stark can provide you with the actual article. Just request it from him in the box to the right. Their conclusion is that only 18% of high-risk eligible adults over 50 get screened at appropriate intervals (annually). In areas of the US where lung cancer incidence is highest (the Southeastern states) the rate of screening was actually much lower than areas where the incidence is lowest (the Northeast).
Why the discrepancy? The authors offer several possibilities. First the number of health-care entities offering this service is small; some commercial insurance companies do not cover the procedure; and the uninsured are unwilling to pay. Not mentioned is a reluctance of many primary-care physicians to bring this up. Mammography and colonoscopy are engrained in our psyches, but probably because of its novelty, lung cancer screening is not.
When we as a society can reduce mortality from a lethal cancer dramatically, it is a shame that we don’t actually do it very well.