Task force: Screen smokers for lung cancer

Posted at 7:22 AM, Jul 30, 2013
and last updated 2013-07-30 07:22:05-04

(CNN) — For the first time the U.S. Preventive Services Task Force is recommending lung cancer screening for people who have a high risk of developing the disease.

People who have a “30 pack year history of smoking” (for instance, at least 2 packs a year for 15 years), who are between the ages of 55 and 79, and who have smoked their last cigarette within the last 15 years are considered high risk.

The USPSTF’s recommendations were published Monday and are subject to a public comment period that ends August 26. When it last looked at this in 2004, the group said the data was insufficient to recommend screening for lung cancer.

The task force’s new recommendations are based on a review of seven clinical trials where researchers found Low-Dose Computed Tomography (CT) scanning was an effective way to detect lung cancer before patients began to show symptoms.

“Close to 160,000 people in the U.S. die from lung cancer every year,” says Dr. Michael LeFevre, co-vice chair of USPSTF. That’s more than breast, prostate and colon cancer deaths combined. LeFevre estimates that screening the right people may prevent up to 20,000 deaths each year.

The USPSTF is now giving lung cancer screening a “B” recommendation. Under the Affordable Care Act new private health insurance plans must cover screenings that receive an “A” or “B” rating with no deductibles or co-pays.

More than a year ago, The American Cancer Society, along with other organizations, made very similar recommendations. But “most health insurance companies have delayed offering coverage for lung cancer screening pending the outcome of the USPSTF review,” Dr. Otis Brawley, chief medical officer of the American Cancer Society, said in a statement. Having insurance cover this type of screening will be a big advantage for patients; a CT scan can cost several hundred dollars and the work-up and follow-up care can also be expensive.

It’s important to note that there are downsides to screening, says to Dr. Kenneth Lin, a former staffer for the U.S. Preventive Service Task Force and nationally recognized expert on cancer screening in primary care. Not every smoker gets lung cancer, and doctors acknowledge that false-positive test results can sometimes lead to invasive procedures, even surgery, for patients who turn out not to have cancer. At minimum the patient will be terrified, Lin says, and at maximum he or she will have a lung biopsy before they are reassured they don’t have cancer. There is also the possibility that the radiation exposure from the CT scan can cause cancer down the line, he says.

Focusing on high-risk individuals who are healthy enough to go through an evaluation and treatment following a positive screening is extremely important, says LeFevre, who’s also a family physician at the University of Missouri-Columbia. “If you wouldn’t be able to tolerate surgery then it doesn’t make sense to screen in the first place.”

Dr. Linda Humphrey, lead author of the studies the USPSTF based their recommendations on, says the ideal scenario would be to shift from late-stage diagnosis to early-stage diagnosis.

Lung cancer is the No. 1 cancer killer of men and women worldwide, according to the American Cancer Society. In most cases it’s not caught until a patient presents with symptoms, when it’s often too late. Humphrey says the task force’s recommendations are “consistent with our work, very true to our work, to what research shows, and balancing risks and benefits.”

Some doctors are concerned that the USPSTF’s definition of who should get screened is too vague. Dr. Peter Bach, a lung physician and epidemiologist, who is not a member of the task force, is concerned about the risk and notes more smokers die from heart disease than lung cancer.

“In this risk group, the best they should look for is a conversation with doctor to understand the individual risk and go from there,” Bach says.

He suggests talking with an impartial provider — like a primary care doctor — who doesn’t stand to gain financially from screening you.

Bottom line: getting screened for lung cancer is not an alternative to quitting smoking, LeFevre says, but screening high risk smokers can prevent a significant number of lung cancer deaths because cancer may be found early enough to be treated.