By Matt Devino, MPH

Lung cancer is the second-most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228,820 people were diagnosed with lung cancer, and 135,720 people died from the disease. Lung cancer has a generally poor prognosis, with an overall five-year survival rate of 20.5 percent. However, early-stage lung cancer has a better prognosis and is more amenable to treatment. According to the American Lung Association, detecting lung cancer in early stage versus late stage can be the difference between life and death. Low-dose computed tomography (LDCT) screening among those at high risk for lung cancer can help detect the disease earlier and has been shown to reduce the lung cancer death rate by up to 20 percent.

On March 9, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation for annual lung cancer screening with LDCT by lowering the recommended age to begin screening from 55 to 50 and lowering the minimum personal smoking history from 30 pack-years to 20 pack-years. The new recommendation for lung cancer screening is for adults aged 50 to 80 years who have a 20 pack-year history and who currently smoke or have quit smoking within the past 15 years.

USPSTF estimates that these changes will almost double the number of at-risk individuals who are eligible for lung cancer screening. The updates will also address the disparity in eligibility for lung cancer screening for some groups who are at higher risk of lung cancer at a younger age and with a lighter smoking history.

According to Kristin Ferguson, DNP, RN, OCN, ACCC’s senior director of cancer care delivery and health policy, the newly revised USPSTF lung cancer screening guidelines will likely be helpful in reducing the current disparity seen among the Black population, who the National Institute on Minority Health and Health Disparities notes as having higher rates of lung cancer, “even though they have lower smoking rates, smoke fewer cigarettes per day, and are less likely to be heavy smokers, compared to Whites."

“While many states through Medicaid expansion fully cover lung cancer screening, the American Lung Association notes that as of September 2020, nine states do not provide coverage,” says Ferguson. “Several studies have shown that in states that have expanded Medicaid, cancer screening rates and the rate of early cancer detection have increased due to reduced out-of-pocket patient costs."

ACCC lung cancer resources:

• ACCC Lung Cancer Home Page
• Improving Care Coordination: A Model for Lung Cancer
• National Non-small Cell Lung Cancer (NSCLC) Quality Care Initiative
• 6 Steps to Improve Lung Cancer Care Coordination
• Fostering Excellence in Care and Outcomes in Patients with Stage III and IV NSCLC

• NIH: Mechanisms of Disparities in Etiology and Outcomes of Lung Cancer in the United States: The Role of Risk and Protective Factors
• American University: Medicaid Expansion Increased Early Cancer Detection, New Study Finds