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The U.S. Preventive Services Task Force (USPSTF) says the benefits of free lung cancer early testing could be significant – especially for women and Black people. This task force is an independent assembly of 16 physicians and scientists who evaluate medications and tests. As a federally appointed group, they have recommended major changes in how, who and when people should begin this testing for lung cancer.

Under the Affordable Care Act, private insurers must cover services, without patient cost-sharing, that receive “A” or “B” recommendations from the task force.  The lung-cancer screening recommendation received a “B” rating.  Medicare also generally follows the group’s recommendations.

Why invest in these additional scans?

Lung cancer is the leading cause of death from cancer. While lung cancer diagnoses are fairly low before the age of 50, it increases rapidly after that age and especially after 60 years of age.

However, the survival rate is higher when the disease is caught in the earliest stages.   The conclusion of the task force was that broadening eligibility for lung cancer screening would save a substantial number of lives each year. 

How should people be tested?

Testing would begin with an annual low-dose computed tomography (LDCT) scan. People with cancer have a much better chance of survival when diagnosed early. This type of screening identifies small possible cancers and has shown a substantially reduced risk of dying from lung cancer.

However, it does have limitations. LDCD doesn’t detect all types of lung cancer. When it does detect cancers, it may not be at an early stage and does not ensure an avoidance of death from the disease. Detection of a false positive is also a possibility. This may mean additional tests and anxiety for the patient.

Who should receive lung cancer early screening?

According to the USPSTF 2021 recommendations:

Adults 50 – 80 who have smoked approximately 1 pack a day for 20 years.

In all cases, the testing is for people who currently smoke or quit within the past 15 years.

Those who develop lung cancer from exposure to asbestos would definitely benefit from earlier and frequent testing. Smoking paired with asbestos exposure leads to a much greater risk for lung cancer than those with similar smoking habits and no asbestos exposure.

What age should testing begin?

According to the new proposed guidelines, testing would start at 50 for those who meet the qualifications. This should be followed with annual checkups.

Is this covered by insurance?

Through a provision of the Affordable Care Act, since this lung cancer recommendation has a “B” rating from the task force, costs are covered by private insurers. There is also no cost-sharing by the patient. Medicare generally follows the task force’s guidance.

Varying opinions on lung cancer early testing

“We have to find these lung cancers early. It’s a very minimal test,” according to Roy S. Herbst, a lung-cancer specialist at the Yale Cancer Center. He is enthusiastic that identifying this cancer at an early stage means a better chance of treating or curing it. Estimates claim fewer than 5 percent of eligible Americans have had screening for lung cancer.

On the more cautious side, Daniel S. Reuland, professor of medicine at the University of North Carolina School of Medicine, co-wrote an analysis of pros and cons. In that analysis he said, “Screening high-risk people with low-dose CT can reduce lung cancer mortality but also causes false-positive results leading to unnecessary tests and invasive procedures, overdiagnosis, incidental finding, increases in distress, and, rarely, radiation-induced cancers.” Follow-up tests can be costly and cause anxiety. He and other physicians believe that along with the screening must be shared decision making between doctors and patients. The pluses and minuses need to be explained to the patient before testing.

Dr.  John Wong, a member of the task force and an internist at Tufts Medical Center in Boston, believes finding a potentially lethal cancer at an early stage far outweighs the harms. Though follow-up tests from a screening might cause some anxiety, “if you miss a lung cancer, then it might spread and shorten your life.”