Lung Cancer Screening Gaps Despite Updated Guidelines
- As 2021, the expansion of lung cancer screening guidelines to include younger individuals and those with a less extensive smoking history has led to an increase in screenings.
- Crane, Ph.D., R.D.N., associate professor and co-leader of the Cancer Control Research Program at Sylvester, noted the impact of the updated guidelines.
- Lung cancer remains the leading cause of cancer-related deaths for both men and women in the United states.
Lung Cancer Screening: Addressing Disparities and Improving Access
Table of Contents
- Lung Cancer Screening: Addressing Disparities and Improving Access
- Lung Cancer Screening: Your Top Questions answered
- What is Lung cancer Screening?
- Who Should Get Screened for Lung Cancer?
- Why is Early Detection of Lung cancer Important?
- What Does the lung Cancer Screening Process Involve?
- What are the Barriers to Lung Cancer Screening?
- How Can Disparities in lung cancer Screening Be Addressed?
- What are the Recommended Screening Guidelines?
- What are the outcomes of Lung Cancer Screening?
- Where Can I Learn more About Lung Cancer Screening?
Published: 2025-03-21
As 2021, the expansion of lung cancer screening guidelines to include younger individuals and those with a less extensive smoking history has led to an increase in screenings. However, notable disparities persist, particularly affecting individuals with limited access to healthcare.This is according to a recent study conducted by researchers at Sylvester Extensive Cancer Center, a part of the University of Miami Miller School of Medicine.
Tracy E. Crane, Ph.D., R.D.N., associate professor and co-leader of the Cancer Control Research Program at Sylvester, noted the impact of the updated guidelines. “the updated guidelines substantially increased lung cancer screenings even as cancer screenings declined during the COVID-19 pandemic,” she said. However, she also emphasized that “discrepancies for who is screened persist, underscoring the importance of addressing structural barriers in rural and underserved populations.” Crane is the senior author of the study, which was published in the March 20 issue of JAMA Oncology.
Lung cancer remains the leading cause of cancer-related deaths for both men and women in the United states. Early detection through screening can significantly improve treatment effectiveness and save lives. Low-dose computed tomography (CT) is a relatively new and effective screening tool for detecting early-stage lung cancer.
The U.S. Preventive Services Task Force (USPSTF) initially issued its lung cancer screening guidelines in 2013.These screenings are designed to be rapid and painless. In 2021, the USPSTF updated these guidelines, lowering the recommended starting age for screening from 55 to 50 and including individuals with a smoking history of 20 or more pack-years, down from the previous threshold of 30 or more. A pack-year is calculated by multiplying the number of years a person has smoked by the number of packs smoked per day.
LaShae D. rolle, M.P.H., C.PH., a Sylvester doctoral research fellow and the study’s first author, analyzed data on health-related risks and behaviors from a nationally representative CDC survey.While the dataset is extensive, it relies on self-reported information, which may lead to underestimation of smoking habits due to recall bias or social desirability.
Rolle’s analysis revealed that prior to the guideline changes, only 15.43% of individuals classified as high-risk were up to date on their lung cancer screenings. Following the guideline update, this percentage increased to 47.08% among eligible individuals. While this represents a significant improvement,it still indicates that less than half of those eligible are receiving the recommended screenings. Screening rates were notably lower among uninsured patients, those without a primary care provider, and residents of rural areas.
Barriers to Lung Cancer Screening Access
Several factors contribute to the disparities in lung cancer screening access.
- Lack of Primary Care Provider: Patients without a primary care provider are less likely to be screened, possibly due to the need for a referral.
- Lack of awareness: many eligible patients may simply be unaware of their eligibility for screening.
- Cost of Care: While health insurance covers approximately 97% of lung cancer screenings, the cost of a scan without insurance can be substantial, along with the cost of a doctor’s visit for a referral.
While options for free or low-cost scans exist through state and non-profit programs, the financial burden remains a significant obstacle for many.
But screening is not a one-time deal. Patients should get a scan annually, and results may require additional testing. The costs come not only from the scan but the follow-up.
Coral Olazagasti, M.D., Sylvester assistant professor of clinical medical oncology
Rolle, a cancer survivor herself, understands the challenges individuals face when weighing healthcare costs against other essential needs. “A person may say - I don’t have the money; I don’t have insurance. But, no one thinks they have cancer,” Rolle said. “I am a cancer survivor myself. I was diagnosed at 26. I understand how easy it is to brush off a screening, especially among those choosing between having food or getting screened.”
Geographic barriers also play a significant role. In rural areas, screening facilities may be located hundreds of miles apart, making travel a major impediment. Mobile lung cancer screening units can improve access in these areas, but their cost can be as high as $2 million.
Strategies for Closing the Screening Gap
Efforts are underway to address the disparities in lung cancer screenings.
At Sylvester, community outreach teams are actively working to reduce these disparities. Estelamari Rodriguez, M.D., M.P.H.,Sylvester’s associate director of community outreach for thoracic oncology,explained,”We have been identifying the places in our catchment area were the highest-risk patients are not getting screened. We then head over in the Game Changer Bus and educate and counsel the public on lung cancer screenings.”
Other strategies to improve screening rates among minority populations include:
- Patient Navigators: Providing education, scheduling assistance, and transportation arrangements.
- Community Partnerships: Collaborating with local organizations, churches, and health workers to build trust and provide culturally sensitive education.
Gilberto Lopes, M.D., sylvester’s chief of the division of medical oncology, emphasized the importance of these partnerships. “Partnering with local community organizations, churches and health workers has proven effective in promoting lung cancer screening,” he said. “Trusted local figures can help overcome mistrust and fear while providing culturally tailored education.”
For Rolle, the issue of lung cancer screening access is deeply personal. ”I was lucky enough to catch my breast cancer early, and now I’m cancer-free. I would love for others to get screened so they can also catch cancer early, too,” she said.
Recommended Screening Guidelines
The American Cancer Society recommends that clinicians initiate a discussion about lung cancer screening with patients aged 55 to 74 years who have at least a 30-pack-year smoking history,currently smoke,or have quit within the past 15 years,and who have access to high-volume,high-quality screening and treatment centers.
The Centers for Disease Control (CDC) emphasizes that the only recommended screening test for lung cancer is low-dose computed tomography (LDCT).
The National Cancer Institute (NCI) states that lung cancer screening with low-dose scans has been shown to decrease the risk of dying from lung cancer in heavy smokers.
Lung Cancer Screening: Your Top Questions answered
Lung cancer is the leading cause of cancer-related deaths in the United States. Early detection through screening can significantly improve treatment outcomes and save lives. This Q&A provides essential details about lung cancer screening, addressing common questions and highlighting critical insights.
What is Lung cancer Screening?
Lung cancer screening is a process to detect lung cancer at an early stage, when it’s frequently enough more treatable. The primary screening method is a low-dose computed tomography (LDCT) scan.
Who Should Get Screened for Lung Cancer?
The U.S. Preventive Services Task force (USPSTF) recommends lung cancer screening for individuals who meet the following criteria:
Age: 50 to 80 years old
Smoking History: 20 pack-year smoking history (a pack-year is calculated by multiplying the number of years a person has smoked by the number of packs smoked per day).
Current Smokers or Former Smokers: Individuals who currently smoke or have quit smoking within the past 15 years.
Access to High-Quality Centers: Those who can access high-volume, high-quality screening and treatment centers.
Note: Always consult with your doctor to determine if lung cancer screening is right for you based on your individual health profile.
Why is Early Detection of Lung cancer Important?
Early detection of lung cancer significantly improves treatment effectiveness and increases the chances of survival. Screening with LDCT can detect lung cancer at an early, more treatable stage.
What Does the lung Cancer Screening Process Involve?
The primary lung cancer screening process involves a low-dose computed tomography (LDCT) scan. This is a rapid, painless, and non-invasive imaging test that uses X-rays to create detailed pictures of the lungs. the LDCT scan can show a radiologist any abnormalities within the lungs. It allows the detection of smaller tumors, improving the chances of triumphant treatment.
What are the Barriers to Lung Cancer Screening?
Despite the benefits, several factors contribute to disparities in lung cancer screening access:
Lack of a Primary Care Provider: patients without a primary care provider are less likely to be screened, potentially due to the need of a referral.
Lack of Awareness: Many individuals eligible for screening are simply unaware that they’re eligible.
Cost of Care: While health insurance covers approximately 97% of lung cancer screenings, the cost of a scan without insurance can be ample, along with the costs of a doctor’s visit for a referral and follow-up testing and treatment.
Geographic Barriers: Screening facilities may be located hundreds of miles apart in rural areas, making travel a major impediment.
How Can Disparities in lung cancer Screening Be Addressed?
Efforts are underway to address disparities in lung cancer screenings:
Community Outreach Teams: Active work to identify and reach high-risk individuals who aren’t getting screened.
Patient Navigators: Providing education, scheduling assistance, and transportation arrangements.
* Community Partnerships: Collaborating with local organizations, churches, and health workers to build trust and provide culturally sensitive education.
What are the Recommended Screening Guidelines?
The American Cancer society recommends that clinicians initiate discussions about lung cancer screening with patients aged 55 to 74 years who meet specific criteria. The Centers for Disease Control (CDC) and the National Cancer Institute (NCI) also emphasize the importance of LDCT scans for screening.
Key Guidelines for Lung Cancer Screening:
| Organization | Suggestion |
| :———————————— | :—————————————————————————————————————————————————————————- |
| American Cancer Society | Discuss screening with patients aged 55-74 years who have a 30-pack-year smoking history, currently smoke, or quit within the past 15 years.|
| Centers for Disease Control (CDC) | Only recommended screening test for lung cancer is low-dose computed tomography (LDCT). |
| National Cancer Institute (NCI) | Low-dose scans have been shown to decrease the risk of dying from lung cancer in heavy smokers. |
What are the outcomes of Lung Cancer Screening?
Research shows that lung cancer screening with LDCT can decrease the risk of dying from lung cancer, especially for heavy smokers. Early detection through screening significantly improves the chances of successful treatment and patient survival.
Where Can I Learn more About Lung Cancer Screening?
Consult with your healthcare provider to discuss your individual risk factors, eligibility, and any questions or concerns you might have about lung cancer screening.