Under new guidelines, millions more people qualify for lung cancer screenings

September 26, 2022
hispanic man, who is now at the age to qualify for lung cancer screening under the new guidelines, with his family.
Lung cancer is the deadliest type of cancer. New guidelines make millions more people eligible for lung cancer screenings. Photo: Getty Images.

Lung cancer is by far the deadliest type of cancer, and newly expanded lung cancer screenings are critical to saving lives.

Lung cancer is the second most common type of cancer, but the leading cause of cancer-related death in the country according to the American Cancer Society. Lung cancer accounts for about one out of every four cancer deaths, killing more people than colon, breast and prostate cancers combined.

Starting this year, millions more people can qualify for lung cancer screening to help detect and treat lung cancer early. Early detection and treatment dramatically boost survival rates.

To provide answers to your questions about lung cancer screenings, we consulted with Dr. Nina Thomas, the director of the lung cancer screening program at UCHealth University of Colorado Hospital on the Anschutz Medical Campus.

Who qualifies now under the new guidelines for lung cancer screenings, and why get screened?

Under new guidelines, patients ages 50 to 77 who currently smoke or quit within the last 15 years and have at least a 20 pack-year smoking history should be screened for lung cancer, Thomas said.

A pack-year is defined by the average amount a person smokes per day multiplied by the total duration of smoking in years. For example, 20 pack-years can be either one pack per day for 20 years or half a pack per day for 40 years.

The new guidelines reduced the age of eligibility to start lung cancer screenings from 55 to 50, and decreased the total smoking history from 30 pack-years to 20 pack-years.

Do you have questions about whether you qualify for lung cancer screening?

Learn more about how to get screened.

Studies have found that African Americans and women can develop lung cancer at younger ages and with less smoking exposure, Thomas said. These findings led to the changes in screening guidelines published last year by the U.S. Preventive Services Task Force, to help bridge that gap in screening for these at-risk populations.

This year, health experts at the Centers for Medicare and Medicaid Services adopted new recommendations, which means screenings are now mostly covered through both private and government-funded health insurance.

Thomas and her team at University of Colorado Hospital are passionate about reaching more people whose lives they could save.

“This could have a huge impact,” Thomas said of the updated screening guidelines. “About 6.5 million more people in the United States will be eligible for screening now. If they are screened appropriately, we can save an estimated 10,000 to 20,000 more people every year.”

Many people who should be screened for lung cancer are not being screened, Thomas said.

There are multiple complex barriers to screening. Unlike mammograms and colonoscopies, with which most people are familiar, lung cancer screening is not as well-known.

“Even before the guidelines changed, fewer than 6% of people who qualified for a lung cancer screening were getting it, even though the benefits are great,” said Thomas, who is also an Assistant Professor of Medicine-Pulmonary Sciences and Critical Care at the University of Colorado School of Medicine.

The benefits of lung cancer screening are even greater than for more commonly accepted screenings like breast and colon cancer, she said.

“To save one life through lung cancer screening, you need to screen 300 people. In comparison, to save one life from breast cancer or colon cancer, you have to screen over 1,000 people,” Dr. Thomas said.

Why aren’t people getting screened for lung cancer?

Medical experts believe that one of the reasons that fewer eligible people are getting screened for lung cancer is that the lung cancer screening guidelines are a little more complex than recommendations for other common screenings.

Mammograms and colonoscopies are recommended based solely on age. In addition to age, lung cancer screening guidelines are also based on risk factors, specifically smoking history.

Most forms of health insurance cover lung cancer screening, but access to care and socioeconomic status still play a major role in preventing appropriate screening.

Stigma can also be a barrier to lung cancer screening given the association with smoking.

“The UCHealth lung cancer screening program prides itself on being non-judgmental,” Thomas said. “We understand the difficulties of quitting smoking and partner with patients to help them. We have dedicated smoking cessation counselors who work with us in our clinics.”

It’s easy for patients to get help and find out if they qualify for screenings.

“To keep things simple, if you’re over age 50 and either you’re still smoking or you quit within the last 15 years, then you may qualify for lung cancer screening,” Thomas said. “You can either call the UCHealth lung cancer screening program in your region or talk with your primary care doctor to learn more about lung cancer screening and if you could benefit from it.”

What does lung cancer screening involve?

Annual lung cancer screenings are easy, quick and painless. It simply involves a yearly low dose CT scan which can be done at many different medical facilities. The scan involves lying on an exam table, fully clothed, and traveling through the CT scanner.

The scan takes a total of about 10 minutes.

“The greatest benefit comes from following up and getting your scan every year. If done consistently, the likelihood that you will die from lung cancer goes down by 20%,” Thomas said.

What happens if you have any evidence of cancer?

If a CT scan detects a concerning lung nodule, or spot on the lung, then you will be evaluated by a specialist to determine the next best steps for diagnosis, which could include further imaging or a biopsy procedure. Not all nodules found on the CT scan represent cancer, Thomas said.

If doctors find evidence of cancer, the patient gets referred to a multidisciplinary team of specialized surgeons, oncologists, radiation oncologists and pathologists who come up with a personalized treatment plan. In one day, you will get a treatment plan and meet with all the providers who will be involved in your care.

“The care is tailored to each patient according to the latest research available,” Thomas said. “And patients are given opportunities to enroll in the newest clinical trials.”

Early diagnosis can make a huge difference for patients, Thomas said.

“A patient’s entire trajectory can be different if they get diagnosed early. Early stage cancers have a higher chance of cure,” she said. “Unfortunately, most patients do not have any symptoms when they first develop lung cancer. They only develop symptoms at later stages of cancer, which is more difficult to treat. That is why screening is so important.”

Thomas said new, advanced treatments are making a big difference in lung cancer survival rates.

“Treatment for lung cancer has evolved dramatically over the last 10 years, giving us hope even for those with late-stage cancers. Lung cancer is no longer a death sentence,” she said.

“At our cancer center, not only do we have advanced treatments, we also have numerous dedicated resources like case managers, social workers, nurse navigators, nutritionists and psychologists to help guide you through the stress of being diagnosed with lung cancer.”

What about people who have smoked large amounts of marijuana for several years. Should they also be screened?

The current guidelines do not include people who smoke marijuana.

That being said, Thomas said people who smoke marijuana heavily can be at greater risk for lung cancer too. The carcinogens from cigarette smoking come from the tar in the cigarettes rather than the nicotine. Marijuana has similar carcinogens when smoked.

“I usually counsel my patients that if you are smoking anything, then you’re likely increasing your risk for lung disease and for lung cancer.”

What about people who use vapes rather than smoking cigarettes?

Vaping “is not 100% safe either,” Thomas said.

“There are other lung diseases associated with vaping, and we don’t know the long-term effects of vaping because it hasn’t been around long enough for adequate studies. In the future, we may learn that vaping increases your risk of lung cancer too.”

Many smokers or former smokers feel ashamed and may avoid medical care. What do you tell these people about the importance of seeing their doctor and getting screenings for lung cancer?

Thomas reminds people that it’s not their fault that they’re addicted to cigarettes.

“There is a long history of the tobacco industry targeting people to get them addicted to their products,” Thomas said.

“We understand that quitting smoking is one of the hardest things. Fortunately, we have several tools and resources available to help you quit. This is a judgment-free zone.

“Smoking cessation counseling is a part of lung cancer screening, so that shouldn’t prevent people from getting screened. We just want to help people quit so they can live longer.”

About the author

Katie Kerwin McCrimmon is a proud Coloradan. She attended Colorado College thanks to a merit scholarship from the Boettcher Foundation and worked as a park ranger in Rocky Mountain National Park during summers in college.

Katie is a dedicated storyteller who loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as an award-winning journalist at the Rocky Mountain News and at an online health policy news site before joining UCHealth in 2017.

Katie and her husband, Cyrus — a Pulitzer Prize-winning photographer — have three adult children and love spending time in the Colorado mountains and traveling around the world.