Low Uptake of Lung Cancer Screening in the US: Why?

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This transcript has been edited for clarity. 

Hello. I'm Dr Maurie Markman from City of Hope. I'd like to discuss a very interesting paper recently reported in JAMA Internal Medicine entitled, “Lung cancer screening in the US, 2022.” Before I begin, as an alert, this is not a positive report. In fact, it's quite discouraging.

This group looked at a population of patients who were eligible to receive screening for lung cancer via low-dose CT. This has been demonstrated very clearly, unquestionably, to be of value and is recommended by the US Preventative Services Task Force — specifically for high-risk individuals aged 50-80 who had a history of 20 or more pack-years of smoking: either currently smoking, still, or who had quit less than 15 years prior to the current date. 

Those are the recommendations, and the data have demonstrated the ability to find early-stage lung cancer.

This group looked at the data from a cross-sectional database looking at the 2022 Behavioral Risk Factor Surveillance System, a nationwide state representative survey of individuals who were aged 50-79. This was self-reported data. 

The bottom line here was that, overall, only 18% — that's less than 1 out of 5 individuals who were eligible — in fact had undergone low-dose CT screening.

This is a safe strategy. Most insurance companies and Medicare and Medicaid Services will pay for it because it's been approved by the Task Force and there has been shown to be a benefit. But in the country, in this evaluation, only 18% of patients have undergone this screening. 

There is obviously a variety of reasons for this, but we really have to ask the question, “Why?” We have a test that is of demonstrated value, that has been shown to save lives, and that can lead to effective therapy, including curative surgery, and yet only 1 out of 5 individuals take advantage of it. 

We have to ask the question, what is happening in this country to have this be the case, and what can we do to make a difference? It’s a very difficult question, but I would argue it's a very important societal question to ask. 

It’s important for a number of screening strategies, but this one in particular because of the tremendous morbidity of treatment for lung cancer, the cost of the treatment, and the extremely high mortality in advanced disease.

Thank you for your attention.

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