Congress Expanding Access to Lung Cancer Screening

Lung cancer is one of the most prevalent cancers in America, and it represents a significant burden for healthcare systems and societies globally. It is the second most common cancer after prostate cancer in men, and also the second most common cancer after breast cancer in women. However, it is the leading cause of cancer death for both men and women, accounting for 25% of total cancer deaths. The majority of lung cancers are diagnosed after a patient’s 65th birthday, with the average age at diagnosis being 70. Therefore, the majority of patients are elderly, and likely have other comorbidities when lung cancer is diagnosed, which could further complicate management of the cancer. Risk for lung cancer is significantly higher in smokers than it is in non-smokers, but the number of new lung cancer cases has begun to decrease since the number of smokers is decreasing. Due to this combination of factors, early detection is essential for curtailing the burden of lung cancer.   

Recent collaborations between Congress and physicians have led to changes in the recommendations for lung cancer screening, which increases the population eligible for screening. These changes were reflected in the updated guidelines from the U.S. Preventive Services Task Force (USPSTF). The USPSTF is an independent board of experts, including physicians, that aims to improve the health of Americans by focusing on avenues within preventative healthcare to reduce the burden and acuity of various conditions. The update lowers the start age of screening from 55 years to 50 years, and also lowers the number of smoking years from 30 years to 20 years. The USPSTF projects these changes will allow for the eligible population to nearly double in size, and also cover populations previously ineligible for screening. This will have a pronounced effect on minority groups, since select minority groups are more likely to have a smoking history above 20 years but below 30 years. Current lung screening consists of annual low dose computed tomography (CT) scans for those at risk for lung cancer or eligible for lung cancer screening. Therefore, by diagnosing lung cancer earlier, there is optimism that more favorable outcomes can be attained for patients. This is supported by a growing number of chemotherapy and immunotherapy drugs in individualized treatment regimens that are capable of producing positive outcomes. 

There is a desire to shift the timing of diagnosis of lung cancer screening, which previously mainly identified lung cancer at advanced stages, when patients were less likely to have favorable outcomes. A goal of physicians is to reach diagnosing 75% of patients with early stage disease and 25% of advanced stage disease. This will allow them to shift to treating patients with minimally invasive surgery without additional chemotherapy or radiation, which would decrease costs on the system and also decrease mortality. 

Concerns exist within the scientific community, which may make it difficult to convince eligible patients to undergo routine screening. One such concern is addressing a patient’s concern about radiation exposure. A single dose of a CT scan has about 10 millisieverts of radiation, which is three times the amount of natural radiation that the average human is exposed to in a year, but less than 10% of the dose needed to significantly increase a person’s risk for developing cancer. There are also patient fears about false positives, which may unnecessarily subject patients to invasive procedures such as lung biopsies. However, to address that concern, the American College of Radiology has devised a metric called the Lung Imaging Reporting and Data System (Lung-RADS) to provide more detailed guidance on which nodules should be biopsied, increasing the burden of evidence needed for a patient to progress to biopsy. Measures such as the Lung-RADS are being taken by legislators and physicians to ensure that widespread access to lung cancer screening will not translate into increased anxiety or fear for patients. 

The USPSTF recommendations from March 2021 emphasize the importance of early detection and were initially designed to increase the uptake of patients who utilized the early screening. Previously, only 15% of Americans who met the criteria for screening actually underwent routine annual screening, and this update hopes to increase that number. This change is projected to save 30,000 to 60,000 lives annually. Additionally, the Affordable Care Act mandates private insurers incorporate USPSTF guidelines into coverage within a year, which provides additional assurance for increased uptake by vulnerable populations. The expanded access to early lung screening presents an opportunity for policymakers and physicians to considerably change the burden of lung cancer in society, saving countless lives and creating a more productive healthcare system in the process. 

Ashwin Palaniappan is a staff writer at BULR and can be reached at ashwin_palaniappan@brown.edu.