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Millions more people should be screened for lung cancer, experts say

New guidelines say 5 million U.S. adults who smoke or formerly smoked should be screened

SHARE Millions more people should be screened for lung cancer, experts say
A doctor holds a chest x-ray.

The American Cancer Society recommends annual screening for those ages 50 to 80 who smoke or formerly smoked and have a 20-year or greater pack-year history.


The American Cancer Society updated its lung cancer screening guideline this week in hopes of reducing the number of people the disease kills.

The guideline, which was released Wednesday, recommends annual screening for those ages 50 to 80 who smoke or formerly smoked and have a 20-year or greater “pack-year” history. A pack-year, according to the patient information page, is “equal to smoking one pack or about 20 cigarettes per day for a year.”

Reuters translated that to a pack a day for 20 years or two packs a day for 10 years.

“A lot of times people don’t consider themselves a smoker because they haven’t smoked in 10, 15 or 20 years,” ACS chief scientific officer Dr. William Dahut said at a press conference quoted by Reuters. “If you have a significant smoking history and quit when you were 28 years old and now you’re 55, he said, ‘you definitely should be screened.’”

The article noted that “the lung cancer risk to former smokers does decrease over time when compared with similar people who continue to smoke. When compared with never-smokers, however, their risks remain three times greater even when 20 or 30 years have passed since they quit, the researchers said.”

The screening tool of choice is a low-dose computed tomography (CT) scan.

The guidance was last updated a decade ago. The new version was published in the journal CA: A Cancer Journal for Clinicians.

Lung cancer is the leading cause of cancer death in the United States and the second-most diagnosed malignancy for both men and women, according to the American Cancer Society. Its researchers estimate that in 2023, 238,240 cases of lung cancer will be newly diagnosed (117,550 in men and 120,790 in women). They also predict 127,070 deaths from the disease, including 67,160 men and 59,910 women.

They note that most people diagnosed with the disease are 65 or older, but anyone, at any age, can get lung cancer.

“This updated guideline continued a trend of expanding eligibility for lung cancer screening in a way that will result in many more deaths prevented by expanding the eligibility criteria for screening to detect lung cancer early,” said the society’s senior vice president, Dr. Robert Smith, in a news release. Smith is the lead author of the screening guideline report.

“Recent studies have shown extending the screening age for persons who smoke and formerly smoked, eliminating the ‘years since quitting’ requirement and lowering the packs per year recommendation could make a real difference in saving lives.”

The society says people who still smoke should receive counseling to help them quit.

The report also notes that some people should not be screened for lung cancer, including those with health conditions that “greatly limit life expectancy or affect their ability or willingness to get lung cancer treatment if diagnosed.”

The previous guideline called for screening those ages 55 to 74 with a 30-plus pack-year history of smoking who had quit within the past 15 years. The years-since-quitting requirement has been dropped and the other eligibility categories expanded.

The advisory notes that although most lung cancers are caused by smoking, people who have never smoked can also develop lung cancer. But “at this time, it’s very hard to tell which people who have never smoked might be at high enough risk for lung cancer to include them in the screening recommendations,” the advisory says.