New guidelines could provide CT scan screening for millions of smokers

Tracy Woolrich's picture
Smokers should get annual lung cancer screening tests.
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The final recommendations have been issued this week by the U.S. Preventive Services Task Force and published in the Annals of Internal Medicine. It is geared towards individuals aged 55 to 80 whose smoking puts them at higher risk of cancer. The official recommendation is that heavy smoker, as well as former heavy smokers. should get annual lung cancer screening tests. To be considered a heavy smoker you would have had to have smoked a pack or more a day for the past 30 years. To be considered a former heavy smoker you would have had to have quit within the past 15 years.

My ex husband would be in this category. He is approaching age 60 and has smoked since he was very young. When we were together he smoked a pack a day. I have heard that since then he has increased to 2 packs a day. That puts him in a very high risk category and he should consider getting screening done. My hope is that he receives the screening in a timely fashion.

In the recommendation, the panel reviewed medical evidence dating back to 2004, and found the benefits of screening high-risk individuals outweighed concerns over the harm of over diagnosing and exposure to radiation from CT scans.

These guidelines are intended to help reduce the numbers of lung cancer deaths annually in the United States. Smoking remains the biggest risk factor for lung cancer and results in over 80% of lung cancer diagnosis in the US every year.

According to the task force’s vice chairman, Dr. Michael LeFevre, that could amount to nearly 10 million people getting screening. That is a very large number, however it could prevent as many as 20,000 deaths a year, LeFevre said, if it’s used correctly. There are concerns however regarding that the correct people get screened. Screening inappropriately, “and we could see more harm than good,” LeFevre cautioned. “There’s a lot of room for what I would call people exploiting the recommendation. I can imagine a street-corner imaging center advertising to invite people in.”

In addition there is concern over exposure of radiation during the recommended lung CT scans that could both increase the risk of cancer as well as incidentally detecting minute slow growing lesions that were never a threat to the individual to begin with. Again however, the benefits still outweigh the risks.

While screening clearly can benefit some people, “the best way to avoid lung cancer death is to stop smoking,” LeFevre added.

The panel gave the screening a "B" recommendation. That means that it is considered moderately certain that the benefits of the scans outweigh the risks. Under the new Affordable Care Act, insurers are required to cover preventive services with a grade of "B" or higher. That would mean that insurers would have to begin paying for the scans, which cost between $300 and $500, according to the American Lung Association. In addition, under new health care law, cancer screenings that are backed by the task force are supposed to be covered with no co-pays. However insurance plans would have up to a year to adopt these new recommendations.

These new guidelines are very much in line with previous recommendations by the American Cancer Society and the American Society of Clinical Oncology.

Quitting smoking
lowers the risk of lung cancer. Even reducing the amount you smoke may help. In one study there was evidence that pointed to individuals that smoked more than 15 cigarettes per day could lower their risk if they reduced the number of cigarettes they smoked daily in half.

Take home message:
Screening is not a substitute for quitting smoking. The most effective way anyone can reduce their risk of lung cancer is to avoid tobacco. If you smoke and want help quitting, try reviewing the American Cancer Society Guide to Quitting Smoking or call them at 1-800-227-2345.

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Sources:

Villeneuve, P. and U. Mao. Lifetime probability of developing lung cancer, by smoking status, Canada. Canadian Journal of Public Health. 1994. 85(6):385-8.

Bach, P. et al. Variations in Lung Cancer Risk Among Smokers. Journal of the National Cancer Institute. 2003. 95(6):470-478.

Godtfredsen, N. et al. Effect of Smoking Reduction on Lung Cancer Risk. Journal of the American Medical Association. 2005. 294(12):1505-1510.

American Cancer Society. Lifetime Risk of Developing or Dying From Cancer. Updated 08/08/10.

CDC

Cancer.Gov

Cancer.gov Screening

NEJM

Lung.org Screening

Cancer.Org

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