This commentary is by Beth Zigmund, M.D., director of lung cancer screening at the UVM Medical Center and an associate professor of radiology at the Larner College of Medicine.
The United States has made tremendous strides in extending the lives of people with cancer, and much of that progress is attributed to early detection. Countless lives have been saved through public awareness and acceptance of screening procedures for common cancers such as breast, prostate, colon and cervical cancers.
But what about screening for the deadliest cancer of all: lung cancer, which kills more people in the U.S. and in Vermont than all these cancers combined?
Lung cancer screening with low-dose computed tomography (CT for short) offers hope for people at risk for this deadly disease and has been available for eligible current and former smokers for nearly a decade.
A large clinical trial, the National Lung Cancer Screening Trial, which concluded in 2011, showed participants who underwent low-dose CT had 20% fewer lung cancer deaths than those who did not.
This compelling evidence — on par with that for breast cancer screening and stronger than that for prostate cancer screening — led to a 2013 recommendation from the United States Preventive Services Task Force that high-risk current and former smokers undergo yearly lung cancer screening. The Affordable Care Act requires Medicare, Medicaid, as well as private insurers to cover the cost of the procedure in full.
The problem is that, despite the strong evidence for lung cancer screening and widespread availability — now, seven centers throughout Vermont offer low-dose CT screening — very few eligible individuals take advantage of this potentially lifesaving procedure.
Lung cancer screening is available to people aged 50 or older who have smoked the equivalent of a pack of cigarettes per day for 20 or more years. Former smokers are eligible if they meet these criteria and have quit within the last 15 years. Nonetheless, only about 14.5% of eligible Vermonters undergo screening for lung cancer, which is nearly triple the national average of 5% but still abysmally low.
The lack of awareness of and participation in lung cancer screening takes a heavy toll. Most people with lung cancer do not develop symptoms until the disease has spread to nearby tissues or distant organs. Five-year survival is about 33% if the disease has spread locally and 6% if distantly.
However, early detection dramatically improves the potential for cure, increasing five-year survival to 60% thanks to implementation of surgical and medical treatments that can stop the disease from spreading.
Why are screening rates so low? At-risk individuals face numerous barriers — for example, concerns about affordability, perceived lack of access, uncertainty about effectiveness, fear of a lung cancer diagnosis, and a sense of being blamed for having smoked.
Those living in rural areas are at greater risk for lung cancer due to higher per capita rates of smoking, but are even less likely to seek screening due to additional factors like longer travel times and cost concerns due to higher poverty rates.
Some people are reluctant due to a lack of information about the procedure itself, which is as simple as lying on a scanner table for a few minutes (not the claustrophobia-inducing MRI type) — without IV lines, medications, or any physical contact — and results in a radiation dose about two to three times that of a screening mammogram.
Overcoming barriers is the first step for those at risk for lung cancer to get the care they need.
The time is long past due for Vermonters to take advantage of lung cancer screening. If you believe you may be eligible, take the first step and speak to your health care provider about whether lung cancer screening is the right choice.
And, if you have questions, the UVM Cancer Center and the Dartmouth Cancer Center, along with Vermonters Taking Action Against Cancer, just launched a public health campaign. You can find information here.
