New Lung Cancer Screening Recommendations Can Reach More Patients But Won't Remove All Barriers

The U.S. Preventative Services Task Force (USPSTF) recently released an updated recommendation addressing lung cancer screening criteria at a sooner rate. The task force says this expansion will be especially helpful to those who face disparities to screening. Although, it won’t cover all disparities.

The Task Force recently changed the lung cancer screening recommendation for former and current smokers to receive an annual CT scan between the ages of 50 to 80 years old and who have smoked at least 20 pack years (about a pack a day for 20 years) over their lifetime.

Previously, the task force recommended a yearly screening for people aged 55 to 80 years old and who have smoked at least 30 pack years.

According to the USPSTF, by expanding who is eligible for screening, the changes to this recommendation will be helpful in finding lung cancer sooner in people who do or don’t experience signs. The task force claims it will especially be helpful to Black people and to women because data has found both groups tend to smoke fewer cigarettes than white men. Additionally, data shows Black people have a higher risk of lung cancer than white people. Because these groups smoke less and Black people have a higher risk of lung cancer, they now have the eligibility of finding potential lung cancer sooner.

However, USPSTF member John B. Wong, M.D., says in the report, to save more lives and ensure that everyone who would benefit is screened, it’s critical that screening is implemented broadly and equitably.

There are more challenges many people face, especially Black people, when attempting to access lung cancer screening.

According to a report by Mirage News, a six-year-long MUSC Hollings Cancer Center study found most Black patients who were diagnosed with lung cancer at their study sites had already progressed to stage 3 or 4 disease. It was also found that there was a number of patients enrolled in the study simply because of incidental findings - they broke their leg and went to the hospital, or they thought they had the flu and had a chest X-ray, which ended up finding lung cancer.

Marvella Ford, Ph.D., a researcher at Hollings, said in the report that this finding was a prime example of the disparities faced for lung cancer screening.

Ford shared other disparities or challenges folks face for lung cancer screening, which includes correctly collecting “pack year” data. Ford and Nichole Tanner, M.D, an MUSC Hollings Cancer Center thoracic oncologist, each claim the problem with this is that tobacco pack-year history is difficult to calculate and often changes based on a patient’s memory and current smoking practices. Studies have shown that self-reported smoking history information recorded in patients’ electronic medical records is wrong roughly 90% of the time, and some patients aren’t even asked about their tobacco use, they said.

Some multi-level barriers to lung cancer screening also include the cost of the screening or copay, reaching people in medically underserved areas who may not engage with the health system and a lack of plain language in educational materials about the dangers of smoking.

Other barriers include transportation to centers that offer lung cancer screening, which may be distant from a person’s community; insurance coverage that varies by state; and screenings that are only available during normal business hours, limiting the ability of those who work full-time jobs to schedule an appointment.

Tanner added that mistrust of the healthcare system and stigma surrounding smoking also prevents those who are at risk from accessing screenings.

“This is the first time physicians are asking patients to come in for a screening not because of age alone, but because of a poor health habit,” Tanner said in the report. “People who smoke are less likely to have a primary care provider, they’re less likely to be insured, and they’re often of a lower socioeconomic status, which are all things that keep people from seeing any providers at all. Reducing stigma is huge because smokers often have a lot of guilt and may feel like their cancer was self-imposed.”

Some strategies they offered to reduce these barriers at a health systems level include:

• Implementing patient navigators to increase uptake among vulnerable populations.
• Providing evidence-based tobacco treatment and counseling that accounts for differences in cultural beliefs and health literacy.
• Researching the feasibility of using mobile health units or telehealth to reach people who face geographic barriers.

“When you look at the fact that Black Americans are nearly 50% less likely to receive surgery for early-stage lung cancer than white Americans, it means that a lot of people are dying unnecessarily and that there’s a lot of room for intervention,” Ford added in the report. “That’s what’s exciting to me. Making lung cancer screening and treatment accessible to broader populations means that we can help people to lead longer, healthier lives, but we need increased funding to do this.”