Published Jun 23, 2021
Cancer screenings are only useful if people actually partake. And a recent analysis of data from Epic Health Research Network suggests that just 12.9 percent of eligible Medicare and Medicaid patients were screened for lung cancer between 2019 and 2021 – despite having insurance coverage.
Nearly 382,000 insured patients were eligible for screening under U.S. Preventive Services Task Force guidelines, but 87 percent didn’t receive a low-dose CT scan to screen for lung cancer, according to the findings .
Researchers say their findings suggest “that while insurance coverage is a factor in screening rates for lung cancer, it is not the only factor preventing eligible populations from being screened.” This is an important realization because if we want to reduce the number of deaths from the most deadly cancer, we need to make sure people are aware of their eligibility and knowledgeable of whether or not the screening is covered by their insurance.
Lung cancer, the second most common type of cancer, is the leading cause of cancer deaths for men and women in the United States. Diagnosis and treatment of the disease can be tricky since symptoms often don’t appear until the cancer has spread. An initial symptom, for example, could be as serious as a seizure if the lung cancer has already spread to the brain. But other symptoms can include increased coughing, chest pain, unexplained weight loss, shortness of breath, wheezing, losing your voice or persistent infections like bronchitis or pneumonia.
The two main types of lung cancer are non-small cell, which makes up 85 percent of cases, and small-cell. These types act differently and, accordingly, require different types of treatment. Dr. Patrick Forde, a thoracic oncologist at Johns Hopkins Medicine, tells SurvivorNet about how distinguishing between the two types – and their subtypes – can be very beneficial.
“Within that non-small cell category, there’s a subtype called non-squamous adenocarcinoma, and that’s the group of patients for whom genetic testing is very important on the tumor,” he explains. “Genetic testing is looking for mutations in the DNA, in the tumor, which are not present in your normal DNA.”
More men and women die of lung cancer than of colon, breast and prostate cancers combined, but how can screenings make a difference? Lung cancer usually affects people above the age of 65, but a small number of people are diagnosed younger than 45 years old.
Many lung cancers are found accidentally, but screening can help doctors diagnose lung cancers at earlier stages of the disease when successful treatment is more likely. Early-stage lung cancers that are removed with surgery may even be curable. But more often than not, lung cancer diagnoses come after the disease has already spread to other parts of the body making it more difficult to treat.
“In about 70 to 80 percent of patients who are diagnosed with lung cancer, unfortunately the cancer has spread outside of the lung and is not suitable for surgery,” Dr. Forde tells SurvivorNet.
But screening methods such as the low-dose computed tomography (CT) scan can save lives – if those who are at risk participate. This test uses a very small amount of radiation to create highly detailed pictures of your lungs to reveal cancer long before initial symptoms. The State of Lung Cancer 2020 report from the American Lung Association found that screening every currently eligible person would save close to 48,000 lives, but only about 6 percent of Americans who are at high risk are actually getting screened.
“The concern is perhaps patients who are on Medicaid or don’t have insurance will not be referred for appropriate screening,” Dr. Forde says. “I think it behooves us all to try and increase the uptake of CT screening in particular, given that it’s been shown to reduce lung cancer mortality.”
You should talk to your doctor about getting a low-dose CT scan (LDCT) or chest x-ray if you are at high risk or if you experience a cough that doesn’t go away, a cough that produces bloody mucus or if you experience chest pain or trouble swallowing or breathing.
Nearly 20 percent of people who die from lung cancer in the United States each year have never smoked or used any other form of tobacco, but smoking is a huge risk factor for the disease since the tobacco in cigarettes is a carcinogen that causes mutations in lung cells and enables the growth of cancer. If you quit smoking, you can significantly reduce your risk of developing the disease, but you don’t go all the way down to the level of a non-smoker.
In March 2021, the U.S. Preventive Services Task Force (USPST) introduced new guidelines which dropped the age of eligibility for lung cancer screening and the number of “pack years,” or number of years a person smoked an average of one pack of cigarettes a day. The new guidelines specify that adults ages 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should be screened. So if someone smoked one pack of cigarettes per day for 20 years, their “pack history” would be 20 years, and they should be screened. But if someone smoked two packs a day for 10 years, they would also have a 20 year “pack history.”
The USPSTF says that expanding screening eligibility will be “especially helpful” to Black people and women and will increase screening access. Data shows that both groups tend to smoke fewer cigarettes than white men. Data also shows that Black people have a higher risk of lung cancer than white people.