Only a small percentage of people in the United States eligible for lung cancer screening are getting it. Let’s look at this. In 2013 the US Preventive Services Task Force (USPSTF) began recommended annual CT scan screening for people between the ages of 55 and 80 who had at least 30 pack-years exposure to cigarettes. This was the first time that the US government had taken this position and was a radical departure from the 2004 recommendation that was non-committal. The ELCAP trial, published in 2006 in the New England Journal of Medicine, changed everyone’s mind. It showed that annual CT could dramatically improve survival for such people. In 2021 USPSTF amended its recommendations to include people with as little as 20 pack years. The data were so impressive that you would have thought that people would be flocking to get screened. So what actually happened?
Dr. Priti Bandi and collleagues from the American Cancer Society’s Surveillance and Health Equity Science, published a sobering article in JAMA Internal Medicine in which they looked at compliance rates for screening. They surveyed almost 26,000 people who met screening criteria. 62% still smoked (!). Median age was 62. The prevalence of lung cancer screening was only 18%. This is in contrast to mammography, where the compliance rate is 76% and colorectal cancer screening (colonoscopy or some other combinations of modalities) where it is 67%. Why was it so low? The authors analyzed their data. Geography played a big role with compliance lowest in Southern states, where, ironically, lung cancer incidence is highest. Insurance coverage was also important, with the insured more likely to get screened despite the fact that many hospitals, in the interests of public health and public relations, have cut the cost of low-dose CT scanning drastically. There were no racial disparities seen.
Dr. Stark weighs in. “From what I have seen physicians have not been proactive in pushing this important life-saving tool. They get pushback when they urge their patients to quit smoking and don’t like to strain relations further by pushing this test. In any event we as a society are not where we should be given the unequivocal benefit from a non-invasive painless test.”