Lung Cancer Screening and the Importance of Awareness

Dennis Schmidt began smoking as a teenager, a common practice back then, particularly in his Catholic high school, which had designated “senior smoking quarters” for students. He maintained a habit of smoking a pack of menthol cigarettes daily for almost four decades.

As a registered nurse at the University of Cincinnati Medical Center and a former Air Force medic, he understood the risks involved. “I tried to quit a couple of times, but, well, they didn’t go well,” said the now 74-year-old Schmidt.

In 2007, he finally succeeded with the help of a new prescription medication that curbed his cravings. “I just stopped and never looked back,” he mentioned.

Despite spending years in health care, Schmidt was unaware that lung cancer screening was now an option for current and former smokers. This recommendation was made by the U.S. Preventive Services Task Force, an independent expert group, back in 2013.

“I thought I was in the clear after all these years of not smoking,” he admitted.

However, during a routine Medicare wellness visit in 2021, his primary care physician asked whether he would be open to a CT scan for lung cancer detection, and he agreed. Shortly thereafter, the results appeared on his patient portal: adenocarcinoma.

“Reading that was shocking,” Schmidt recalled. “I knew what that meant: cancer.”

Even with a significant drop in smoking rates, lung cancer continues to be the leading cause of cancer deaths in the U.S., with an estimated 125,000 deaths expected this year—outpacing fatalities from colon, breast, or prostate cancer.

Yet, in 2024, among patients eligible for lung cancer screening, only about a quarter—or, possibly even fewer, depending on the data—were up to date with the recommended annual scans.

“That’s incredibly low, especially given how deadly lung cancer is,” commented Dr. Chi-Fu Jeffrey Yang, a thoracic surgeon at Mass General Brigham and author of a recent editorial on screening rates.

Older patients, particularly those over 65, tended to be more compliant, yet still only about a third were screened regularly. In contrast, Schmidt had been consistent with his colonoscopies and prostate checks for years.

Data from national registries indicate that older adults face significantly higher risks for lung cancer. “Age is a general risk factor for cancer,” noted Priti Bandi, an epidemiologist at the American Cancer Society. Though around 20% of lung cancer cases arise in non-smokers, smoking is still the predominant cause, even if the exposure occurred earlier in life.

Research has shown that screening can save lives. A pivotal trial in 2011 found that annual screenings with low-dose CT scans led to a 20 percent reduction in lung cancer mortality compared to previous chest X-rays, prompting initial recommendations.

Further studies from Europe indicated even greater drops in mortality rates. For instance, Italian researchers noted that after ten years, those screened for six years experienced a 39 percent decline in lung cancer deaths compared to non-screened individuals.

So why, then, is screening still not widely utilized? “Lung cancer screening is straightforward, just a two-minute scan,” Dr. Yang remarked. “You don’t even need to change into a gown.”

One reason may be the complexities in determining eligibility. The task force updated its criteria in 2021, recommending screening for individuals aged 50 to 80 with a “20 pack-year” smoking history who currently smoke or quit within the past 15 years.

These guidelines can be challenging for both patients and providers. “Pack-year” requires calculating how heavily someone has smoked over time—smoking a pack daily for 20 years results in a 20 pack-year history, as does smoking half a pack daily for 40 years.

The stigma surrounding smoking might also contribute to this issue, with some patients hesitant to disclose their tobacco use. “There’s often a blame game: ‘You did this to yourself by smoking,’” Dr. Yang reflected. Screening rates also fluctuate based on state and insurance coverage.

Nonetheless, advancements in lung cancer treatments, such as minimally invasive surgeries and effective drug therapies, mean that a diagnosis today isn’t necessarily a death sentence. “Survival rates have dramatically improved,” Dr. Bandi noted.

About 80 percent of patients diagnosed in the early stages of lung cancer survive five years or longer, although survival rates drop for more advanced stages. Screening plays a crucial role in catching cancer early.

Some healthcare professionals express frustration over the underutilization of this potentially lifesaving tool, advocating for changes in the Preventive Services Task Force recommendations, which influence Medicare coverage (Medicaid varies by state) and many private insurers. “The current screening guidelines are too limiting,” Dr. Yang argued.

The American Cancer Society and the National Comprehensive Cancer Network have both modified their guidelines recently, removing the 15-year requirement, which allows more patients to qualify for screening regardless of how long ago they quit smoking.

“We were excluding individuals from screening while their risk was still increasing,” pointed out Robert Smith, a screening expert at the society, and his colleagues have encouraged the task force to eliminate the 15-year rule, backing their request with data.

The cancer network further suggested eliminating both the 15-year and pack-year criteria, advocating for screening anyone who smoked for 20 years.

The task force, facing scrutiny from Health and Human Services Secretary Robert F. Kennedy Jr., has not yet responded to the American Cancer Society’s request for reassessment, nor to inquiries about potential revisions in their lung cancer screening guidelines.

While there are downsides to expanding eligibility for screening—like the likelihood of discovering abnormalities that may not be lung cancer but require further testing—Schmidt’s experience was successful. He was diagnosed with Stage 1 lung cancer following his 2021 screening, leading to robotic surgery at the University of Cincinnati Cancer Center to remove part of his right lung.

Follow-up scans occurred every six months, then yearly, until a 2025 scan found another small nodule in his lower lung, also Stage 1 cancer, which was subsequently removed. Now, Schmidt takes a targeted anticancer medication daily for three years while continuing regular check-ups.

“The screening did what it was designed to do,” Schmidt reflected. “I feel fortunate.” He tends to his expansive gardens in Bright, Indiana, enjoys flying kites, and goes camping with his grandchildren. He continues to work a few shifts each month as a fire department paramedic.

Experts emphasize, however, that lung cancer screening and treatment can’t replace the benefits of quitting smoking entirely. “The risk diminishes the longer you’re away from cigarettes,” Dr. Woloshin said. “But it never truly goes to zero.”