Business has been slow for Allina Health's lung cancer screening program, despite a new federal recommendation that many chronic smokers over 55 should get checked.

The apathy might seem surprising, given how long it's taken to find an effective early-detection system for the nation's leading cancer killer. But Dr. Lee Kamman, an Allina pulmonologist, said the public remains confused about who pays for screening and which smokers should receive it.

Then there's the societal view of lung cancer — that it can be a consequence of personal choice — which might discourage patients from getting tested.

"Women are very good about getting … mammograms," Kamman said. "But that culture of having a lung cancer screening is just not there."

The lung cancer screening consists of three low-dose CT scans over three years for signs of lung abnormalities. (Allina isn't the only local provider; Hennepin County Medical Center announced last week that it will offer $99 lung cancer screenings.)

The U.S. Preventive Services Task Force recommended the screening for current smokers, or those who quit within 15 years, aged 55 to 80 who had a 30 pack-year habit.

The "pack-year" concept could also be confusing to smokers. It could mean smoking a pack a day for 30 years, or smoking two packs a day for 15 years, Kamman said. "It's not that easy for patients to figure this out."

Health systems such as Allina could help by creating reminders in electronic medical records that flag doctors when patients meet the screening criteria. "Primary care doctors have just a zillion things to think about," Kamman said.

The basis for screening was a 2011 finding that CT scans reduced lung cancer mortality in a high-risk group of smokers by 20 percent.

While exposure to CT radiation is a health concern, Kamman said the doses for lung cancer screening are weaker and present less risk, especially to older adults.

CT scans also find a variety of other concerns, including lung abnormalities that don't require medical attention. Extra tests and resulting delays can be stressful. "The screening definitely works," Kamman said, "but it also picks up a lot of things that aren't cancer. You've got to be able to deal with those findings, as well."

The Affordable Care Act obliges insurers to cover tests such as lung cancer screening that receive top grades from the Preventive Services task force. Minnesota insurers are updating their coverage policies to reflect the new rule.