Thursday, April 1, 2021

New U.S. guidelines urge doubling of people that should get annual lung-cancer cat-scans

New federal guidelines could almost double the number of people advised to get yearly lung-cancer screenings.

The point, according to a recent story by Denise Grady in The New York Times, is to include more women and Black and young people.

Early discovery of the disease, the most deadly cancer, could help "cure it in more people at high risk because of smoking," the Times piece says. In those individuals, the article indicates, "annual CT scans can reduce the risk of death from cancer by 20 to 25 percent, large studies have found."

The story quotes Robert Smith, a Ph.D. and screening expert at the American Cancer Society, as saying, "Part of the low uptake is simply lack of access to credit. Smoking in general is increasingly concentrated in lower-income populations."

He contends that "researchers have found that half the population eligible for lung-cancer screening had either no insurance, or Medicaid" — but an editorial in the medical journal "JAMA" explained that not all Medicaid plans cover the screening.

What that means, Smith says, is that there "could be a 15-year period when you might quality for screening and not have any insurance."

Grady also quotes Dr. Mara Antonoff, a lung surgeon at the M.D. Anderson Cancer Center in Houston, to the effect that some studies "have alluded to some hormonal influences in women. In terms of racial differences, we don't have an answer. We have population-based data to show they have a tendency to develop lung cancer younger and with less exposure to tobacco, but we don't have a mechanism."

The article indicates that "14.5 million people would qualify for the screening" — representing an increase of 6.4 million. But researchers "estimate that only 6 to 18 percent of those who qualify and could be helped by the screening have taken advantage of it."

One reason could well be the cost — $300. Some who need the scans most simply "may not be able to afford them," the story postulates. 

CT scans — casually called cat-scans and formally called computerized tomography — provide much more detailed information than ordinary X-rays.

The story, based on advice published in "JAMA," says the new recommendations by the U.S. Preventive Services Task Force "include people ages 50 to 80 who have smoked at least a pack a day for 20 years or more, and who still smoke or have quit within the past 15 years."

Earlier U.S. guidelines were based on males, who tend to smoke more heavily, the Times reports, further noting that women and Black Americans "tend to develop lung cancer earlier and from less tobacco exposure than white men, experts said."

Why the risk appears to differ by race and gender, the story says, "is not known."

The Times piece also suggests that Smith and other researchers believe a good portion of patients "may be missing out on lung-cancer screening because they just don't know about it" — or because some doctors may not strongly encourage it.

The statistics are grim. "There were 228,820 new cases of lung cancer in the United States in 2020," Brady writes, "and 135,720 people died from it, according to the National Cancer Institute. About 90 percent of cases occur in people who smoke, and current smokers' risk of developing the disease is about 20 times that of nonsmokers."