localized lung cancer is 61%. Unfortunately, only 19% of lung cancers are diagnosed at this early stage, whereas 55% are diagnosed once the cancer has metastasized, at which point the five-year survival rate drops to less than 9%.6 This is why early detection of lung cancer is so important; if we can detect lung cancer at an early stage, available treatment options and prognosis are both better. The Current State of Lung Cancer Screening The national screening rates for breast cancer, cervical cancer, and colon cancer average around 73%. However, in 2019, only 5.7% of high-risk individuals were screened for lung cancer, less than a tenth of the average for the other cancers.7 Figure 3: National screening rates among high-risk populations in the United States, 2019. The low smoking rates in Utah may lead you to the conclusion that this is not our problem. On the contrary, only 2% of high-risk individuals in Utah were screened in 2022.8 This ranks us 45th as a state. Over the last five years, the lung cancer screening rate in Utah did not significantly change, but with your commitment, you can become an advocate for this cause and for your patients. What Can Be Done? The gold standard for lung cancer screening is a low-dose CT scan (LDCT). In an LDCT, only about 1–1.5 millisieverts of radiation are necessary,9 which is about a fourth of a full chest CT. A population-based randomized control trial initiated in 2000 entitled the NELSON trial, confirmed the life-saving benefit of lung cancer screening by LDCT.10 The NELSON trial consisted of two groups followed over the course of 10 years. A total of 13,195 men and 2,594 women between the ages of 50 and 74 were randomly assigned to periodically undergo LDCT screening or no screening. Figure 4: Lung cancer incidence and mortality rates as reported in the NELSON Trial In the screening group, 58.6% of lung cancers were diagnosed at stage I; in the non-screening group, 13.5% of lung cancers were diagnosed at stage I. In the LDCT group, there was a 24% reduction in lung cancer mortality in men and a 33% reduction in lung cancer mortality in women when compared to no screening. Thus, early detection translates to a reduction in mortality. Should Your Patient Be Screened? In March 2021, the United States Preventive Services Task Force (USPSTF) updated the guidelines for lung cancer screening.11 According to current eligibility requirements, a person must: 1. Be between age 50–80 2. Currently smoke or have smoked in the past 15 years 3. Have a 20 pack-year smoking history or greater [Note: 1 pack-year = smoking 1 pack per day for a year] While these new guidelines have nearly doubled the number of eligible individuals for lung cancer screening, they only include individuals with heavy smoking histories. There are other risk factors for lung cancer that are not accounted for in the current screening guidelines, such as secondhand smoke exposure and radon, that should be considered at the provider’s discretion.12 If your patients are eligible, it is recommended that they get screened for lung cancer annually. continued from page 34 | 36
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