A recent study from Northwestern Medicine indicates that current lung cancer screening guidelines may overlook a significant number of patients who develop the disease. Published in the journal JAMA Network Open, the research analysed nearly 1,000 lung cancer patients treated between 2018 and 2023. The findings suggest that it’s time to reconsider the existing recommendations from the U.S. Preventive Services Task Force (USPSTF).
Under current guidelines, annual CT scans are recommended for adults aged 50 to 80 who have a smoking history of 20 pack-years and who are either current smokers or have quit within the last 15 years. Alarmingly, only about 35% of those diagnosed with lung cancer met these criteria. This means that approximately two-thirds of lung cancer patients were not flagged for testing before their diagnosis.
Dr. Luis Herrera, a thoracic surgeon at Orlando Health, emphasized the limitations of these criteria. “Not only does that approach miss many patients who had quit smoking in the past or did not quite meet the high-risk criteria, it also misses other patients at risk of lung cancer, such as non-smokers,” he explained. The study revealed that those who fell outside the recommended guidelines often had adenocarcinoma, the most common type of lung cancer among never-smokers.
The research also found that the demographic of patients not meeting screening criteria tended to include more women, individuals of Asian descent, and people who had never smoked. In comparing survival outcomes, the study noted that patients who did not qualify for screening lived a median of 9.5 years, compared to just 4.4 years for those who did qualify.
While earlier detection and tumor biology contribute to these survival rates, the study underscores how current screening protocols leave a substantial number of cases undetected. Dr. Herrera, who was not involved in the study, pointed out the low participation rates in lung cancer screening among eligible patients, attributing this to complex risk criteria and the stigma surrounding smoking and lung cancer.
To address these shortcomings, researchers modeled an alternative approach that advocates for screening all adults aged 40 to 85, regardless of their smoking history. This universal, age-based screening model could detect approximately 94% of cancers within their study cohort. According to the researchers, implementing such a change could potentially save about 26,000 lives annually in the U.S. at an estimated cost of $101,000 per life saved, a figure that is significantly more cost-effective compared to current screening programs for breast or colorectal cancer.
Despite the promise of these findings, challenges remain in the adoption of broader lung cancer screening practices. Dr. Herrera noted that awareness and recommendations from healthcare providers are significant barriers. Nonetheless, he reassured that the cost of screening is generally covered by health insurance, and many institutions offer discounts for uninsured patients.
Lung cancer remains the leading cause of cancer-related deaths in the United States, claiming more lives annually than colon, prostate, and breast cancers combined. The current narrow eligibility criteria based primarily on smoking history leaves millions at risk without appropriate screening. Researchers from Northwestern Medicine argue that expanding the screening criteria to include all adults within specified age ranges could bridge significant gaps in early detection, particularly for often underdiagnosed groups.
Though the study was conducted in a single academic centre, which may not fully represent the broader U.S. population, it raises important considerations for future lung cancer screening protocols. The findings highlight the need for a reevaluation of screening guidelines to ensure that at-risk populations receive timely and potentially life-saving interventions.
