Proposed changes to lung cancer screening guidance could increase scans among Black patients, women

Aprominent panel of physicians and other medical experts recommended Tuesday that a wider swath of people in the U.S. be screened for lung cancer every year — a suggestion that would see more Black patients and women eligible for potentially lifesaving scans.

The U.S. Preventive Services Task Force, which advises the federal government on preventive care, released a draft recommendation that would nearly double the number of people eligible for annual CT scans to check for lung cancer. The proposal would start annual screenings at age 50 among people who are at high risk because of their smoking history, instead of the current recommendation of 55. It would also encompass people without the heaviest smoking histories currently used to determine whether a person is at high risk of lung cancer.

The panel said that changing the guidelines could lead to higher screening rates among Black patients and women, who tend to smoke fewer cigarettes than white men — and, in the case of Black patients, are also at higher risk of lung cancer.

“Some really good news from the changes to this recommendation is that it will mean more people are eligible for screening, including notably more African Americans and women,” said John Wong, a physician at Tufts Medical Center and member of the task force. “Making screening for lung cancer available to people who have smoked less over time will help doctors support the health — and potentially save the lives — of more of their African American and female patients.”

That part of the recommendation involves reducing the number of “pack years” that make an individual eligible for screening. A pack year is a way of calculating how much a person has smoked. One pack year is the equivalent of smoking an average of 20 cigarettes, or one pack, per day for a year. The task force’s existing recommendation for eligibility is 30 pack years, but the new recommendation would drop it to 20.

Lung cancer is the leading cause of cancer death for both men and women in the U.S., and more than 200,000 new cases are diagnosed each year. If lung cancer is found at an earlier stage, before it has the chance to spread, it has a higher chance of being successfully treated.

“Lung cancer screening is very important to early diagnosis and much earlier treatment of lung cancer. By exposing more individuals who are at high risk to the opportunity to be screened means we can save more lives,” said Mara Antonoff, a physician and assistant professor at MD Anderson Cancer Center.

Smoking and older age are the two most important risk factors for lung cancer, according to the USPSTF. Smokers are approximately 20 times more likely than nonsmokers to develop lung cancer. That risk increases with the years someone has smoked, as well as how many cigarettes that person has smoked.

Experts said the recommendations could raise new awareness about lung cancer screenings.

“The idea of lung cancer screening, unfortunately, has not received the attention that it needs,” said Antonoff, who said that the stigma around smoking is likely to blame.

“There are a lot of folks who feel like, ‘Well, if you smoke cigarettes then you’re to blame if you get lung cancer,’” she said. “That’s not the way to treat humanity. That’s not the way to cure disease. And that’s not the way to prevent disease.”

The draft recommendation will now be opened for public feedback, which members of the task force encouraged.

“The task force feels very strongly about transparency and making recommendations,” said Michael Barry, a physician and member of the task force. “Anyone can comment. And we take those comments very seriously and can commonly tweak recommendations to help make things more clear for all.”