July 29th, 2013
05:01 PM ET

Task force: Screen smokers for lung cancer

Editors note: This story was initially published in July. We're republishing because the final USPSTF recommendation was issued Monday.

For the first time the U.S. Preventive Services Task Force is recommending lung cancer screening for people who have a high risk of developing the disease. People who have a "30 pack year history of smoking" (for instance, at least 2 packs a year for 15 years), who are between the ages of 55 and 79, and who have smoked their last cigarette within the last 15 years are considered high risk.

The USPSTF's recommendations were published Monday. When it last looked at this in 2004, the group said the data was insufficient to recommend screening for lung cancer.

The task force's new recommendations are based on a review of seven clinical trials where researchers found Low-Dose Computed Tomography (CT) scanning was an effective way to detect lung cancer before patients began to show symptoms.

"Close to 160,000 people in the U.S. die from lung cancer every year," says Dr. Michael LeFevre, co-vice chair of USPSTF. That's more than breast, prostate and colon cancer deaths combined. LeFevre estimates that screening the right people may prevent up to 20,000 deaths each year.

The USPSTF is now giving lung cancer screening a "B" recommendation. Under the Affordable Care Act new private health insurance plans must cover screenings that receive an “A” or “B” rating with no deductibles or co-pays.

More than a year ago, The American Cancer Society, along with other organizations, made very similar recommendations. But "most health insurance companies have delayed offering coverage for lung cancer screening pending the outcome of the USPSTF review," Dr. Otis Brawley, chief medical officer of the American Cancer Society, said in a statement.  Having insurance cover this type of screening will be a big advantage for patients; a CT scan can cost several hundred dollars and the work-up and follow-up care can also be expensive.

It's important to note that there are downsides to screening, says to Dr. Kenneth Lin, a former staffer for the U.S. Preventive Service Task Force and nationally recognized expert on cancer screening in primary care. Not every smoker gets lung cancer, and doctors acknowledge that false-positive test results can sometimes lead to invasive procedures, even surgery, for patients who turn out not to have cancer. At minimum the patient will be terrified, Lin says, and at maximum he or she will have a lung biopsy before they are reassured they don't have cancer. There is also the possibility that the radiation exposure from the CT scan can cause cancer down the line, he says.

Focusing on high-risk individuals who are healthy enough to go through an evaluation and treatment following a positive screening is extremely important, says LeFevre, who's also a family physician at the University of Missouri-Columbia.  "If you wouldn't be able to tolerate surgery then it doesn't make sense to screen in the first place."

Dr. Linda Humphrey, lead author of the studies the USPSTF based their recommendations on, says the ideal scenario would be to shift from late-stage diagnosis to early-stage diagnosis.

Lung cancer is the No. 1 cancer killer of men and women worldwide, according to the American Cancer Society.  In most cases it's not caught until a patient presents with symptoms, when it's often too late.  Humphrey says the task force's recommendations are "consistent with our work, very true to our work, to what research shows, and balancing risks and benefits."

Some doctors are concerned that the USPSTF's definition of who should get screened is too vague.  Dr. Peter Bach, a lung physician and epidemiologist, who is not a member of the task force,  is concerned about the risk and notes more smokers die from heart disease than lung cancer.

"In this risk group, the best they should look for is a conversation with doctor to understand the individual risk and go from there," Bach says.

He suggests talking with an impartial provider – like a primary care doctor – who doesn't stand to gain financially from screening you.

Bottom line: getting screened for lung cancer is not an alternative to quitting smoking, LeFevre says, but screening high risk smokers can prevent a significant number of lung cancer deaths because cancer may be found early enough to be treated.

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Filed under: Cancer • Conditions • Smoking

soundoff (25 Responses)
  1. bob

    If you still choose to smoke, in this day and age, I say you get what you deserve. You're poisoning yourself and the people around you. People who choose to live healthy lifestyles should not be endangered because someone needs their nicotine fix.

    July 29, 2013 at 17:44 | Report abuse | Reply
    • cali girl

      Have you seen the groups of 20 something's that pick up the habit? Not like the word is not out on smoking, the cancers, heart and lung issues, with the added bonus that your second hand smoke does in everyone around you. Another peeve is having to walk into a business and someone who is so wrapped up in their smoking is standing right next to the door. So you have to pass through the cloud in order to get to the business.

      July 29, 2013 at 19:45 | Report abuse |
    • LL11

      So how healthy is your lifestyle? Do you avoid fast-food? Fried foods? Make sure you get 5-6 vegetable/fruit servings a day? Drink only water? Exercise 4-5 times a week? If not, why should we pay for your heart-attack or diabetes or colon cancer?

      You sound like my sister. Who said, when my aunt died of some lung disease (not cancer but can't remember) as a complication of her smoking "well she brought it on herself". What compassion. When my Dad got colon cancer I asked her if that was HIS fault for his poor eating habits. She replied "that's different". You two both sound like hypocrites....

      FYI, as an EX-smoker, I can answer yes to all the questions I posed. Well I drink tea as well.

      July 30, 2013 at 16:46 | Report abuse |
    • SA Indiana

      Oh Bob, we can all only wish to be as perfect as you.

      July 30, 2013 at 18:52 | Report abuse |
    • Portland tony

      Unfortunately, the older generation already suffers from the damage done. But, if you never start or stop early in life , you're gonna be so much better off health wise with one less thing to worry about as you age!

      July 30, 2013 at 19:22 | Report abuse |
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      August 5, 2013 at 11:50 | Report abuse |
    • Neil

      Bob sounds delightful

      August 8, 2013 at 17:42 | Report abuse |
  2. Portland tony

    With second hand smoke included, almost everyone in the world be needed to be screened. All people eventually die of something or become so feeble or ill they probably want to. So lets screen everybody over 50 for every known disease even if we can't completely cure it we would guarantee you'd live 3 months longer after surgery, chemotherapy and a miserable bed ridden existence ....so we can tell you what you will probably die from and even when we cure one disease we can't guarantee you won't die from another next month.

    July 29, 2013 at 18:25 | Report abuse | Reply
  3. Lung Cancer Alliance

    A monumental moment in the fight against lung cancer.  
    Find out if you're at risk, and if you are, get a scan www.AtRiskForLungCancer.org

    July 29, 2013 at 18:50 | Report abuse | Reply
  4. cali girl

    What about those of us who had no choice? Parents who each smoked 2 packs a day was the air I breathed.

    July 29, 2013 at 19:42 | Report abuse | Reply
  5. Rosi

    "Not every smoker gets lung cancer, and doctors acknowledge that false-positive test results can sometimes lead to invasive procedures, even surgery, for patients who turn out not to have cancer. At minimum the patient will be terrified..."

    Seems like being "terrified" would be great incentive to stop smoking!

    July 30, 2013 at 04:21 | Report abuse | Reply
  6. Ken MD

    Important confirmation of prior study, but your reporting will cause needless anxiety. a "30 pack year history" of smoking represents 2 packs A DAY for 25 years, not 2 packs a year for 15 years. You really should correct that error.

    July 30, 2013 at 05:29 | Report abuse | Reply
    • MD2008

      Two packs a day every day for 15 years...

      July 30, 2013 at 14:57 | Report abuse |
    • MS

      Just to clarify: a 30 pack-year history would be 2 packs a day for 15 years, not 25 years. Or 1 pack a day for 30 years, etc.

      July 30, 2013 at 14:57 | Report abuse |
    • Ken MD

      Thanks for the typo corrections. 2 packs a day for 15 (not 25) years represents a 30 pack year history of smoking.
      The value of screening at the prior threshold of 20 pack years is less clear.
      Ms. Henry should post the correction that the current study does NOT support CAT scan screening for those who have the radically lesser history of 2 packs a year for 15 years.

      July 30, 2013 at 17:04 | Report abuse |
  7. MD2008

    Someone who has smoked 2 packs a day for 15 years has wasted close to $100,000, maybe more depending on where one lives. WOW. Think about what you could do if you did not smoke: live without lung cancer and have an extra $100,000 to spend on something worthwhile.

    July 30, 2013 at 15:04 | Report abuse | Reply
    • LL11

      As an ex-smoker (finally, after MULTIPLE attempts), I agree with you, expensive and nasty habit. No one thinks, however, they won't be able to quit (yes, we're fools, usually very young fools).

      Just curious though, about your figures though. How expensive are cigarettes where you are? I calculated at current costs at my 5 year mark (of quitting) I had saved around $9700. that was at a pack a day. And really, cigarettes, used to be much cheaper, until the states and feds thought taxing smokers more heavily a good way to make money (another great reason to quit if needed) but cartons used be under $20.

      July 30, 2013 at 16:39 | Report abuse |
  8. SA Indiana

    This is great news! There are plenty of tests that have been around that can help detect chances of certain diseases, heart disease being one and bone scans to determine risks for osteoporosis. This isn't about smoking or not smoking, this is about detection and a higher chance of survival. . To every person that has watched a loved one die of lung cancer, smoker or non-smoker, this is a major medical accomplishment. I hope all of you perfect non-smokers never come down with a preventable disease. Geez. Lets not turn this forum into a smokers bashing discussion unless you intend to bash every bad habit of americans. Smokers are well aware of the risks and dangers.

    July 30, 2013 at 18:51 | Report abuse | Reply
  9. Johnboy Stone

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    Was serious and would've defined your rights,hence.

    July 30, 2013 at 23:01 | Report abuse | Reply
  10. RecoveringNicotineAddict

    Smoking isn't a habit. It's a drug addiction, and a powerful one. Those not addicted to nicotine cannot understand why it's so hard to quit, unless maybe they regularly wake up in the morning full of self-revulsion because they ate another pint of ice cream at midnight. I quit eleven years ago and fit the criteria for screening, and plan to do so in January when it'll be offered in my town. But, I am comforted to know that while my risk for lung cancer is still ten times a never smoker, the actual odds are 4%. So, I've got a 96% statistical chance of avoiding it. But, to be in the 4% really, really sucks.

    October 30, 2013 at 12:49 | Report abuse | Reply
  11. Diana

    I am a smoker, have been for many, many years. Have tried to quit several times, will try again. Tired of being bashed, I try to be considerate (no smoking by business doors, don't blow smoke in people's faces, keep ashes and butts cleaned up), but am now an "outsider" among my peers. I don't like feeling this way, I will continue to try to quit. Until that time, we all need to keep our noses in our own business and work on our own bad habits – WE ALL HAVE THEM!

    December 31, 2013 at 11:26 | Report abuse | Reply
    • Nobody you know

      While I sympathize with how difficult it is to quit, your last statement is not exactly meaningful. Yes, we all have bad habits, but not all of them impact others' health. Smoking does.

      December 31, 2013 at 13:43 | Report abuse |
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