Lung Cancer Screening Gap Persists as Disease Remains Leading Global Cancer Killer: Sora Ely, MD

Celebrated throughout February, National Cancer Prevention Month underscores the importance of prevention and early detection across malignancies. In an interview with The American Journal of Managed Care^®, Sora Ely, MD, a thoracic surgeon at GW Cancer Center, emphasized the critical role of screening for lung cancer, which remains the leading cause of cancer-related death globally and in the US, where it claims more lives annually than the next 3 most common cancers combined.

Current US Preventive Services Task Force lung cancer screening guidelines recommend annual low-dose CT scans for individuals aged 50 to 80 with at least a 20–pack-year smoking history who currently smoke or have quit within the past 15 years. However, Ely highlighted persistently low uptake, with national screening rates below 10%. By contrast, screening rates for breast cancer typically exceed 70%, underscoring the need for improved awareness and implementation efforts.

This transcript has been lightly edited for clarity.

Why should non–small cell lung cancer (NSCLC) be a priority during National Cancer Prevention Month?

I know we're going to focus on screening, but in terms of actual prevention, tobacco prevention has been very, very effective, and those efforts are really where we focus in terms of prevention. However, it’s worth mentioning that never-smokers can absolutely and do still get lung cancer, and there are some other risk factors for it, but in terms of why it should be a priority, lung cancer is still the No. 1 cancer killer globally, in the US, and in every state.

So, it's a pretty big deal, and it kills more people, at least in the US, annually, than the next 3 biggest cancers combined. If we want to really focus on reducing cancer death, lung cancer is the way to do it.

NSCLC is often diagnosed at an advanced stage. Why has early detection historically been more challenging in lung cancer compared with other malignancies?

I'm not sure exactly why it took a bit longer to develop a good screening test for lung cancer. I think maybe some of it is that, because, ultimately, the test that we use is a low-dose CT scan of the chest. CT scans were developed, obviously, a bit later compared with x-rays and other things that we use, like for mammography; that may be why, and it's not that we weren't trying.

Historically, there were a number of studies looking at chest x-rays to try to do screening for lung cancer, and they did not find a strong benefit. But we had the National Lung Cancer Screening Trial, and that was using low-dose CT scans instead to annually screen for lung cancer. They found a 20% reduction in lung cancer-specific mortality. Ever since then, in 2014, shortly after that came out, the US Preventive Services Task Force had recommended annual lung cancer screening with a low-dose CT scan for qualifying individuals.

I think one of the other barriers has been identifying people at significant risk. For most other cancers, it's age-related only, or gender, of course, for breast cancer, but it's a bit more complicated to identify people at sufficient risk to be eligible for screening for lung cancer.

Can you outline the current US lung cancer screening guidelines? How successfully have they been implemented nationwide?

The current guidelines recommend that persons aged 50 to 80 who have at least a 20–pack-year smoking history and are either still smoking or quit less than 15 years ago should get an annual low-dose CT scan. Pack-years, to clarify, are essentially a way of quantifying the amount of cigarettes you smoked over time, so it's simply multiplying the packs per day by the number of years smoked.

As an example, if a person has smoked 1 pack per day for 20 years, 1 times 20 is 20, so they have met the 20–pack-year criterion. Alternatively, if someone only smoked half a pack per day, but they smoked for 40 years, one-half times 40 is 20, so they also would meet the 20–pack-year guideline.

In terms of how successfully they've been implemented nationwide, we have done a terrible job, unfortunately, pretty much universally. Recently, there have been a few exceptions that are doing better, but still not great. We have had low uptake of lung cancer screening. Nationally, the rates are probably less than 10%.

Just as a contrast, national screening rates for breast cancer and colon cancer typically exceed 70%, so there's a lot of work left to be done in getting eligible folks screened.

Reference

The National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/nejmoa1102873