1. Fuerst, Mark L.

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CHICAGO-The vast majority of heavy smokers are not screened for lung cancer, despite federal recommendations, according to a new study.

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An analysis of 1,800 lung cancer screening sites nationwide found that only 1.9 percent of more than 7 million current and former heavy smokers were screened for lung cancer in 2016, despite U.S. Preventive Services Task Force (USPSTF) and ASCO screening recommendations.


Since 2013, the USPSTF has recommended annual screening for lung cancer with low-dose CT (LDCT) for high-risk smokers ages 55-80 years and those who smoked 30-pack years and who currently smoke or have quit within the past 15 years. In 2012, ASCO and the American College of Chest Physicians issued a joint guideline with these same recommendations. In 2015, Medicare coverage was expanded for lung cancer screening with LDCTs.


"Lung cancer screening rates are much lower than screening rates for breast and colorectal cancers, which is unfortunate," said lead author Danh Pham, MD, a medical oncologist at the James Graham Brown Cancer Center at the University of Louisville, Ky. "It is unclear if the screening deficit is due to low provider referral or perhaps patient psychological barriers from fear of diagnosis. Lung cancer is unique in that there may be stigma associated with screening, as some smokers think that if cancer is detected, it would confirm they've made a bad lifestyle choice."


Pham presented the results of the study, the first assessment of lung cancer screening rates since recommendations were issued in 2013, at a press briefing ahead of the 2018 ASCO Annual Meeting (Abstract 6504).


Pham and colleagues gathered data from the 2016 American College of Radiology's Lung Cancer Screening Registry on people who received LDCT at nearly 1,800 accredited screening sites. They compared that data to 2015 National Health Interview Survey estimates of eligible smokers who could be screened based on the USPSTF recommendations.


Their analysis of the data was based on four U.S. census regions in the country: Northeast, South, Midwest, and West. The screening rate was calculated by dividing the number of LDCT scans by the number of smokers eligible for screening per USPSTF recommendations.


Key Findings

The researchers found that the South had the most accredited screening sites (663) and the highest numbers of smokers who were eligible for screening (3,072,095). However, the screening rate in the South was only 1.6 percent, the second lowest in the country, whereas the West had the lowest rate at 1 percent and the lowest number of accredited screening sites (232). The highest screening rate was in the Northeast (3.5%), and the Midwest had the second-highest rate of 1.9 percent.


Nationwide, a total of 1,796 accredited screening centers could have screened 7,612,975 eligible current and former heavy smokers, but only 141,260 people received LDCT screenings, making the nationwide screening rate 1.9 percent. By comparison, about 65 percent of women age 40 or older had a mammogram in 2015, said Pham.


Approximately 85 percent of the screened current smokers were offered smoking cessation resources, which was documented by providers prior to screening referral. The percentage of current and former heavy smokers offered cessation programs did not vary significantly by census region.


"Annual LDCT screening remains inadequate following USPSTF recommendations, especially when compared to the other known cancer screenings. The results beg the question of whether physicians are not referring enough or perhaps patients do not want screening. Controversy still exists among providers," said Pham. "Effective screening can prevent 12,000 premature lung cancer deaths per year."


He noted that smoking cessation is a modifiable risk factor. "Regardless of the measure, this is a call to action to increase awareness and provide more research," Pham said. To increase lung cancer screening, the most radical step would be to make this a national health quality measure, like colon cancer screening.


Next Steps

The next step for the researchers is to start looking at 2017 lung cancer screening rates. Preliminary data shows there is a small overall uptick in screening rates in 2017 across all regions, Pham explained.


ASCO President Bruce E. Johnson, MD, Professor of Medicine at Harvard Medical School, Boston, commented: "This study makes a strong case that our country needs an effective public service campaign about encouraging lung cancer screening. Public service campaigns from the 1990s encouraged women to get mammograms, saving many lives in subsequent years. We need something similar to encourage current and former heavy smokers to get screened for lung cancer.


"It's disappointing how uncommon screening is. There is a certain stigma among smokers that they feel they deserve it," he continued. "The message is that people in this risk pattern should get screened for lung cancer."


Mark L. Fuerst is a contributing writer.