Expert Panel Says More Smokers Should Be Tested for Lung Cancer

More people with a long history of smoking should be tested annually for lung cancer, even if they’ve quit in recent years, according to new guidance released Tuesday by a government-backed panel of health experts.

The U.S. Preventive Services Task Force routinely reviews and guides preventative health care services in the country. Though officially a government agency, their guidelines are crafted by relevant outside experts brought in on a volunteer basis. On Tuesday, the agency’s experts issued new guidelines for lung cancer screening, which were also published in the medical journal JAMA.

The recommendations call for people between the ages of 50 and 80 years old with at least 20 pack-years of smoking to be screened annually for lung cancer. A pack year is defined as having smoked the equivalent of a pack—which has 20 cigarettes—a day for a year. People who have smoked that much but since quit are still advised to be screened, so long as they had quit within the past 15 years. Those who had quit more than 15 years ago or who have conditions that would affect their life expectancy or willingness to undergo lung surgery are not recommended for screening.

The USPTF’s recommendations aren’t just polite advice; they greatly influence insurance coverage, meaning that more Americans should now be eligible for lung cancer screening through their current health plans.

The new guidelines are more expansive than the most recent set, which were released in 2013. The previous version called for the screening of people between the ages of 55 to 80 years old with 30 pack-years of smoking. According to the USPTF authors, new evidence since then has shown the likely benefits of earlier screening for people with a lighter smoking history. A modeling study also published in JAMA on Tuesday, for instance, found that this new criteria would prevent more lung cancer deaths over the long run compared to the previous guidance, with few added harms.

The study modeled what would happen if everyone who was eligible and born in 1960 was screened for lung cancer via a low dose CT scan, the standard screening test. The new guidelines would be expected to prevent 503 deaths per every 100,000 people screened, compared to 381 preventable deaths per every 100,000 under the old criteria.

Importantly, the new guidelines might also help shorten certain gaps in cancer care. Although smoking remains the leading risk factor for lung cancer, the incidence of lung cancer is higher among Black Americans than other racial groups, and it’s thought that Black and Native Americans are more at risk from lung cancer at lower levels of smoking. Women also might get screened more now, since they generally smoke less on average than men.

“According to our analyses, the new recommendations will reduce disparities in lung cancer eligibility by sex and race, which hopefully will result in reductions in lung cancer disparities in the U.S.,” Rafael Meza, an associate professor of epidemiology at the University of Michigan School of Public Health who led the new modeling research published in JAMA, said in a statement released by the university.

Currently, lung cancer is the second-most common cancer in the U.S., accounting for more than 200,000 confirmed cases a year. And while the number of lung cancer deaths has steadily declined over the decades, it’s still the leading cause of cancer death in the U.S. This year, approximately 131,880 Americans are expected to die from it.