2018 ASCO: Majority of Heavy Smokers Not Screened for Lung Cancer, Despite USPSTF Recommendations

Key Points

  • Nationwide, a total of 1,796 accredited screening centers could have screened 7,612,965 eligible current and former heavy smokers, but only 141,260 people received low-dose CT screenings.
  • The South had the most accredited screening sites (663) and the highest numbers of smokers who were eligible for screening (3,072,095). Nonetheless, the screening rate in the South was only 1.6%, the second-lowest in the country.
  • The West had the lowest rate at 1.0% and the lowest number of accredited screening sites (232). The highest screening rate was in the Northeast (3.5%), and the Midwest had the second-highest rate of 1.9%. 

An analysis of 1,800 lung cancer screening sites nationwide found that only 1.9% of more than 7 million current and former heavy smokers were screened for lung cancer in 2016, despite U.S. Preventive Services Task Force (USPSTF) and ASCO screening recommendations. Results from this study—the first assessment of lung cancer screening rates since those recommendations were issued in 2013—were presented at a press briefing in advance of the 2018 ASCO Annual Meeting and will be presented by Pham et al at the upcoming meeting in Chicago (Abstract 6504).

Lung Cancer and Screening

“Lung cancer screening rates are much lower than screening rates for breast and colorectal cancers, which is unfortunate,” said lead study author Danh Pham, MD, a medical oncologist at the James Graham Brown Cancer Center, University of Louisville, Kentucky. “It is unclear if the screening deficit is due to low provider referral or perhaps patient psychological barriers from fear of diagnosis. Lung cancer is unique in that there may be stigma associated with screening, as some smokers think that if cancer is detected, it would confirm they’ve made a bad lifestyle choice.”

Lung cancer is by far the leading cause of death from cancer, with an estimated 154,040 deaths projected to occur in 2018 in the United States. The USPSTF recommends that people aged 55 to 80 years who are current or former heavy smokers (have smoked at least 30 cigarette pack-years) be screened for lung cancer using low-dose computed tomography (CT). (Cigarette pack-years are calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person smoked.) In 2012, ASCO and the American College of Chest Physicians issued a joint guideline with these same recommendations. According to Dr. Pham, patients who are screened with low-dose CT have about a 20% lower risk of dying from lung cancer.

Study Details

The study’s researchers gathered data from the 2016 American College of Radiology Lung Cancer Screening Registry of people who received low-dose CT at nearly 1,800 accredited screening sites. They compared these data to 2015 National Health Interview Survey estimates of eligible smokers who could be screened based on the USPSTF recommendations. The analysis of the data was based on four U.S. census regions in the country: Northeast, South, Midwest, and West. The screening rate was calculated by dividing the number of low-dose CT scans by the number of smokers eligible for screening per USPSTF recommendations.

The authors found that the South had the most accredited screening sites (663) and the highest number of smokers who were eligible for screening (3,072,095). Nonetheless, the screening rate in the South was only 1.6%, the second-lowest in the country, whereas the West had the lowest rate at 1.0% and the lowest number of accredited screening sites (232). The highest screening rate was in the Northeast (3.5%), and the Midwest had the second-highest rate of 1.9%.

Nationwide, a total of 1,796 accredited screening centers could have screened 7,612,975 eligible current and former heavy smokers, but only 141,260 people received low-dose CT screenings. The annual nationwide screening rate was 1.9%. By comparison, about 65% of women aged 40 or older had a mammogram in 2015.

Approximately 85% of the screened current smokers were offered smoking cessation resources, which was documented by providers prior to screening referral. The percentage of current and former heavy smokers offered cessation programs did not vary significantly by census region.

The authors have already started looking at 2017 lung cancer screening rates, and, preliminarily, there is a small overall uptick in screening rates in 2017 across all regions. The authors added during the press briefing that effective screening may prevent approximately 12,000 premature lung cancer deaths annually.

Commentary

“This study makes a strong case that our country needs an effective public service campaign about encouraging lung cancer screening. Public service campaigns from the 1990s encouraged women to get mammograms, saving many lives in subsequent years. We need something similar to encourage current and former heavy smokers to get screened for lung cancer,” said ASCO President Bruce E. Johnson, MD, FASCO. “We hope this [study] will be a call to action,” he added during today’s press briefing.

This study received grant funding from the Bristol-Myers Squibb Foundation. Author conflict of interest disclosures are available at the end of the study abstract.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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