Primary care physicians in the United States are failing to offer lung cancer screening for long-term smokers, resulting in a complete failure to diagnose lung cancer. In 2012, the American Lung Association issued evidence-based guidelines recommending the annual screening with low-dose CT of long-term smokers over 55 who smoke or smoked within the last 15 years. The U.S. Preventative Services Task Force, American Cancer Society, American Association for Thoracic Surgery, American College of Chest Physicians and the National Comprehensive Cancer Network followed and recommended the same screening guidelines because screening was shown to save lives. Yet, despite the recommendations of these six prominent medical associations, only 2% of eligible smokers are being screened in the United States. This results in over 12,000 needless deaths from lung cancer each year that could be prevented with early diagnosis through the screening guidelines alone.
In 2006, the New England Journal of Medicine issued a ground-breaking article showing how the annual screening of smokers led to an early diagnosis with an 85% survival rate. In 2011, another article appeared in the New England Journal of Medicine confirming that screening smokers saved lives. The standard for screening eligible long-term smokers was finally established when the medical societies issued their guidelines. Payment for lung cancer screening became covered under Medicare and Medicaid in 2015, and many private insurance plans also cover screening. Even without insurance, the price for a scan is $250.
Primary care physicians have focused on getting patients to stop smoking for many years but telling patients to stop simply isn’t enough. Most people who die from advanced lung cancer are not current smokers, because the risk of lung cancer in long-term smokers lasts for 15 years after the last cigarette.
Primary care physicians are also getting confused by the epidemiological data that looks at the whole population and states that the decrease in overall mortality from lung cancer with screening is only 20%. The inference is that screening makes only a small difference. However, for the individual, screening makes a huge difference. Screening starts with an asymptomatic smoker with no cough or symptom. That person undergoes annual screening scans which makes it more likely that any cancer will be diagnosed as an early stage 1 lesion, with a 75% chance of cure with surgery alone. While many factors may explain the 20% decrease in overall mortality from screening in the population, only one factor determines whether a smoker survives lung cancer or not – early diagnosis through screening.
Primary care physicians must inquire about their patients’ smoking habits, past and present. If patients are 55 or over with a 30-pack-year history of smoking and have smoked in the last 15 years, their doctors should offer them low-dose CT screening for lung cancer. A smoker deserves to know that a $250 test can mean the difference between life and death. If you are or were a long-term smoker, you should talk to your primary care doctor about a low-dose CT lung cancer screening.
Thanks to our friends and contributors from Britcher Leone, LLC, for their insight into medical malpractice.