Dennis Schmidt took up smoking as a teenager, a habit so common then that his Catholic high school even had designated “senior smoking quarters” for students to take breaks. For almost four decades, he smoked menthol cigarettes daily.
Working as a registered nurse at the University of Cincinnati Medical Center and having served as an Air Force medic, he recognized the dangers of smoking. “I tried to quit a couple of times, but those attempts didn’t go well,” recalled Schmidt, now 75.
It wasn’t until 2007 that he finally succeeded in quitting, thanks to a prescription medication designed to curb cravings. “I put them down for good,” he said.
Even with his medical background, Schmidt was unaware that lung cancer screenings were available for smokers, whether current or former. The U.S. Preventive Services Task Force recommended these screenings in 2013.
He thought he was in the clear after years of not smoking.
However, during his annual Medicare wellness visit in 2021, his primary care doctor asked if he would consider a CT scan for lung cancer detection. He agreed, and a few days later, the results revealed he had adenocarcinoma.
“Reading that was shocking,” Schmidt said. “I knew what it meant: cancer.”
Lung cancer continues to be the leading cause of cancer deaths in the U.S., with an estimated 125,000 fatalities in the coming year. This number far surpasses deaths from colon, breast, or prostate cancers.
Yet, in 2024, only about a quarter of those eligible for lung cancer screening were current with the recommended annual scans. This rate is considered “unacceptably low, especially given lung cancer’s deadly nature,” according to Chi-Fu Jeffrey Yang, a thoracic surgeon and a senior author of a recent JAMA editorial on screening rates.
Patients over 65 tend to be more compliant with screening than younger individuals; still, only around a third undergo screenings regularly, which is significantly lower than those receiving other types of cancer screenings. For instance, Schmidt had successfully undergone colonoscopies and prostate tests for years.
Statistics indicate that older adults have substantially higher risks for lung cancer. “Age is a general risk factor for most cancers,” said Priti Bandi, an epidemiologist with the American Cancer Society. While about 20% of lung cancer cases occur in non-smokers, smoking remains the predominant cause, even if it happened long ago.
Screening is crucial and has been proven to save lives. A pivotal clinical trial in 2011 demonstrated that annual low-dose CT scans cut lung cancer deaths by 20% when compared to the older chest X-ray method, leading to the initial task force recommendations.
Further studies in Europe have shown even greater reductions; for instance, Italian researchers found a 39% decline in lung cancer deaths in those screened over ten years.
So, why is screening still underutilized? “It takes just two minutes and you don’t even need to change into a gown,” Yang noted. Yet, figuring out eligibility can be complex. The task force updated its guidelines in 2021 to recommend screening for individuals aged 50 to 80 with a significant smoking history and who either currently smoke or quit within the last 15 years.
Both patients and doctors often find these criteria confusing. The term “pack-year” can be tricky to understand, as it reflects smoking intensity over time—smoking a pack daily for 20 years equals a 20 pack-year history, but it could also result from smoking half a pack for 40 years. Calculating this can be complicated and time-consuming, especially with changing smoking habits over the years.
Additionally, there is a stigma around smoking that might discourage some from disclosing their tobacco use. “People sometimes think, ‘You brought this on yourself by smoking,’” Yang commented. Screening rates also vary based on location and insurance coverage.
Nonetheless, advancements in lung cancer treatments have significantly improved survival rates. “A diagnosis is no longer a death sentence,” Bandi remarked. Those diagnosed in the early stages have greater than 80% chances of surviving for five years or longer, though this drops considerably with later-stage cancers. Screening improves the likelihood of early detection.
Recognizing the potential of underused screening, some healthcare professionals are pushing for changes to the guidelines established by the Preventive Services Task Force, which dictate coverage by Medicare and many private insurers. “The current screening guidelines are overly restrictive,” Yang said.
The American Cancer Society and the National Comprehensive Cancer Network have both eliminated the 15-year requirement from their recommendations, allowing individuals to be eligible for screening even if they’ve stopped smoking longer ago.
“We were effectively excluding people from screenings when their risk was still increasing,” explained Robert Smith, a screening expert at the society. He and his peers have requested that the task force revisit its 15-year rule, presenting findings to support their argument.
The cancer network has gone further, recommending screenings for anyone who has smoked for at least 20 years, regardless of the other criteria.
The task force has come under scrutiny, particularly from Health and Human Services Secretary Robert F. Kennedy Jr., but has yet to publicly respond to the American Cancer Society’s findings or queries regarding potential updates to lung cancer screening guidelines.
However, expanding eligibility can have its downsides. Some screenings might uncover abnormalities that aren’t cancerous, leading to additional scans and potential anxiety. Plus, repeated screenings, even with low doses, come with some radiation exposure.
A recent study showed that less than half of older adults with metastatic lung cancer received treatment. “To actually reduce lung cancer deaths through screening, it has to be followed up with treatment,” noted Steven Woloshin, a researcher from the Dartmouth Institute for Health Policy and Clinical Practice.
For Schmidt, however, the screening process worked as it should. The initial mass discovered during his screening was stage 1 lung cancer, which led to robotic surgery at the University of Cincinnati Cancer Center to remove part of his lung.
Surveillance scans were conducted every six months, then annually. A scan in 2025 discovered another small nodule, also stage 1 cancer, which was subsequently removed. Schmidt is currently on a targeted daily anticancer drug regimen while maintaining regular scans.
“The screening did what it was supposed to do,” Schmidt shared. “I feel grateful.” He enjoys tending to his extensive gardens in Bright, Indiana, flying kites, and camping with his grandchildren. He also works part-time as a fire department paramedic.
Experts emphasize, though, that lung cancer screening can’t replace the benefits of quitting smoking— or never starting at all. “The longer you stay away from cigarettes, the lower your risk,” Woloshin added. “But it never goes down to zero.”
