Lung cancer screening rates in US ‘simply unacceptable’
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Less than 6% of eligible Americans have undergone lung cancer screening, according to American Lung Association’s 2022 State of Lung Cancer report.
Screening participation is “critically low” across the country, report authors concluded, with rates as low as 1% in individual states.
“It is hard to understand what the barriers are to lung cancer screening,” Hossein Borghaei, DO, MS, chief of the division of thoracic medical oncology at Fox Chase Cancer Center, told Healio. “The roughly 6% screening rate indicated in this report is simply unacceptable. It is also hard to know if screening is being offered but not accepted by individuals who are eligible, but I doubt that is a reason. Other screening studies such as mammography have been accepted more widely and are conducted at a higher rate than lung cancer screening.”
The fifth annual State of Lung Cancer report includes statistics on several national trends in lung cancer — such as new cases, rates of early-stage diagnoses, survival rates and the percentage of individuals diagnosed who do not undergo treatment.
An estimated 14.2 million Americans meet the U.S. Preventive Services Task Force recommendation for lung cancer screening. The task force recommends annual screening with low-dose CT scan for individuals aged 50 to 80 years who have a 20 pack-year smoking history and either currently smoke or quit within the past 15 years.
Only 5.8% of Americans who meet those criteria have undergone lung cancer screening, according to the report. Analyses by state show rates are lowest in California (1%) and Nevada (1.3%) and highest in Massachusetts (16.3%).
Among the report’s key findings:
• The 5-year survival rate for people with lung cancer is 25% nationwide, one of the lowest for any cancer type.
• The 5-year survival rate for people diagnosed with early-stage disease is considerably higher (61%); however, only 25.8% of cases are diagnosed at early stages.
• Nearly half (44%) of lung cancer cases are detected at late stages, and 5-year survival for this group is only 7%.
• Lung cancer screening with annual low-dose CT scans for those at high risk could reduce the lung cancer death rate by up to 20%.
• About one in five (20.8%) people in the United States diagnosed with lung cancer undergo surgery, which is indicated for early-stage disease that has not spread.
• A comparable percentage (20.6%) of people with lung cancer do not undergo any treatment. Report authors cited several potential reasons, including stigma associated with the disease, lack of patient or provider knowledge about potentially effective therapies, costs of treatment or patient fatalism after diagnosis.
The report also highlighted several disparities in lung cancer diagnosis, treatment and survival based on race.
• White individuals appeared more likely to be diagnosed at an early stage (27%) than Black (23%), Latino (23%), Asian/Pacific Islander (22%) and American Indian/Alaska Native (23%) individuals.
• White individuals underwent surgical treatment more often than American Indian/Alaska Native individuals (21% vs. 17%).
• White individuals appeared more likely to receive treatment (80%) than Asian/Pacific Islander (79%), Black (78%), American Indian/Alaska Native (78%) or Latino (74%) individuals.
• Five-year survival rates also appeared higher among white individuals (25%) than Asian American/Pacific Islander (23%), Black (22%), Latino (19%) or American Indian/Alaska Native (19%) individuals.
“The discrepancies along the racial divide [are] hard to accept,” Borghaei told Healio. “Is it a matter of resources or lack of knowledge on the part of practitioners that leads to this unacceptably low screening rate?”
The improved survival among individuals diagnosed at early stages underscores the importance of screening, he added.
“Chemotherapy and immunotherapy have also been shown to improve survival rates in some subgroups after surgery, but lung cancer has to be detected at an earlier stage for these treatments to be effective,” Borghaei told Healio. “We need more education and training for everyone, and we need to engage patient advocacy groups more to empower everyone to ask for lung cancer screening when they meet with their physicians and other health care providers.”
Report authors highlighted one positive trend, as the 5-year survival rate for lung cancer across the United States increased by 21% between 2014 and 2018.
“Increased lung cancer survival is attributable to advancements in research, better treatments and other factors; however, lung cancer screening is the most immediate opportunity we have to save lives,” Harold Wimmer, national president and CEO for American Lung Association, said in a press release.
Perspective
Back to TopRohit Kumar, MD
Lung cancer screening is the only screening that requires a shared decision-making visit/discussion before the scan. That adds a step in the process and creates time constraints/ delays. In addition, breast and colon cancers are easy to screen for — anyone aged older than 40 or 45 years, respectively. For lung screening, you have to remember the eligibility criteria. EMRs do not spontaneously alert primary care providers. The cost of CT is another limitation. Adherence is another difficult piece – systems do not generate reminders for patients or PCPs.
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