Early detection and clinical intervention are essential to decreasing mortality rates for lung cancer. The vast majority of lung cancer cases are identified when a patient is evaluated for another health issue and/or is experiencing classic signs and symptoms (e.g., cough, hemoptysis, dyspnea, weight loss) associated with lung cancer. In some cases, lung cancer is detected when an abnormality is found on imaging in an asymptomatic patient, and some cases are diagnosed via screening. Every patient with suspected lung cancer should undergo a thorough history and physical examination, including attention to nonpulmonary symptoms that may indicate metastasis.
When evaluating a patient suspected of having lung cancer, it is critical for clinicians to differentiate non–small cell lung cancer (NSCLC) from small cell lung cancer (SCLC) to ensure that the appropriate treatment regimen is selected and tailored to patient need. In general, SCLC is more aggressive than NSCLC, and patients may have a central lesion with hilar and mediastinal invasion together with regional adenopathy. The majority of patients with SCLC present with metastatic disease at diagnosis, and the most common sites of lung cancer metastasis are the bones, liver, adrenal glands, pericardium, brain, and spinal cord.
The American Lung Association indicates that the method by which cancer is diagnosed varies from patient to patient. Clinicians generally consider various factors, including medical history, symptoms, and findings from physical examination and tests (e.g., hematological laboratory tests) to confirm the diagnosis.
The United States Preventive Services Task Force (USPSTF) first issued lung cancer screening recommendations in 2013, and in 2021 it expanded the criteria for lung cancer screening eligibility. The USPSTF recommends annual low-dose computed tomography (LDCT) in an eligible high-risk group, which is now defined as individuals aged 50 to 80 years who currently smoke or formerly smoked, with a 20 pack-year or greater smoking history, and who have smoked within the past 15 years. More information can be found here.
In early November 2022, more than 50 cancer organizations, including four dozen cancer centers, associations, and advocacy organizations, issued a joint statement to address the underutilization of screening for lung cancer, stressing that considerable action is essential to prioritize early detection of lung cancer via expanded screening for high-risk individuals. The group noted that to reduce lung cancer mortality nationwide, the U.S. must expand lung cancer screening in individuals considered to be high-risk. Unfortunately, only 5.7% of Americans considered to be at high risk for developing lung cancer had a recent LDCT screening examination for lung cancer.
This new effort aligns with and supports the national Cancer Moonshot Initiative, which aims to reduce cancer deaths by 50% over the next 25 years. Lung cancer screening is one simple approach to help achieve that goal, and this call to action provides guidance for national support, including public funding and health-policy changes necessary to substantially increase lung cancer screening.
The group also indicated that a number of barriers exist that prevent high-risk individuals from being screened, including a lack of awareness in both patients and providers. According to the consensus statement, numerous factors limit the participation of high-risk individuals in lung cancer screening via low-dose CT. These factors include, but are not limited to, inconsistencies in state Medicaid coverage for lung cancer screening; challenges in recognizing, enrolling, and navigating patients through lung cancer screening; awareness gaps between providers and patients; and deficiencies in quality incentives at the health-system level.
The experts noted that for the U.S. to fully realize the benefits of screening, it must pursue collaborative and innovative strategies to reach individuals at high risk for developing lung cancer. They also mentioned that access to lung cancer screening has improved over the past decade thanks to insurance-coverage requirements in the Affordable Care Act and expansion of eligibility criteria under the USPSTF 2021 recommendation.
In a recent news story, Michael Hanley, MD, a lung cancer screening expert at UVA Health Cancer Center stated, “Unfortunately, greater than 70% of lung cancers are detected too late, when the chance for a cure is much lower. The goal of screening is to detect cancers early on, when there is a high chance for a cure and a return to normal life.”
Findings from a new study presented at the 2022 American Society of Clinical Oncology Annual Meeting revealed that the use of LDCT for lung cancer screening may have resulted in a significant reduction in advanced lung cancer. The researchers aimed to confirm that the implementation of LDCT will yield an earlier lung cancer diagnosis and thereby decrease the prevalence of later stages of lung cancer. The presenter, Dr. Maxwell Akanbi, stated, “It appears that low-dose cancer screening may be effective in reducing the incidence of advanced lung cancer in the general population without leaving behind minority populations, but the impact on mortality is yet to be determined.”
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
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