Pain has piled up in this long pandemic year, not just in deaths but in growing mental health concerns and alcohol consumption. Another public health challenge — smoking — has remained on the back burner, but no longer. The U.S. Preventive Services Task Force last week decreased the eligible age for lung cancer screenings from 55 to 50, including those with shorter smoking histories, to more than double the number of eligible adults from 7.8 million to more than 14 million. Among those most likely to benefit are women and minorities. Lisa Gebhard, manager of lung health at the American Lung Association (ALA), tells us more.
Q: The new guidelines came out on the anniversary of this country's COVID response. Coincidence? Or were cancer specialists concerned about a year of isolation and increased smoking?
A: To our knowledge, there was nothing intentional about releasing the new guidelines the same week, but it's a good opportunity to highlight these changes. The updated guidelines have been in the works for several years.
Q: Related to that, might you have numbers that suggest increases in smoking over the past year?
A: Recent data released from the North American Quit Line Consortium showed a dramatic 27% drop in calls to help quit smoking during 2020. It comes as no surprise that people were focused on the pandemic, managing stress and economic concerns, and found it hard to concentrate on quitting smoking. Sales of cigarettes, which had been decreasing for years, showed a 1% increase, according to data from the U.S. Treasury Department.
Q: What type of screening is used?
A: A low-dose CT (computed tomography) scan, which is a special kind of X-ray that scans and takes multiple pictures of the lungs. A computer then combines these images into a picture far more detailed than traditional X-rays. Screening is essential to saving lives because screening helps catch cancer before there are any symptoms. It usually detects cancer in early stages like Stage 1 when it is more treatable and easier to remove with surgery.
Q: Why is this good news for people of color and women?
A: They are among groups who will have some of the largest increases in eligibility with the new recommended guidelines. The ALA's 2020 "State of Lung Cancer" report showed that people of color who are diagnosed with lung cancer face worse outcomes compared to white Americans because they are less likely to be diagnosed early, less likely to receive surgical treatment, and more likely to not receive any treatment. The expanded criteria will more than double the number of Black and Hispanic people eligible for screening and increase the number of American Indians and Alaskan Natives eligible by 2.7-fold. Close to twice as many women will also be eligible for screening under the revised guidelines.
Q: Will screenings be covered by all health insurance companies?
A: Medicare and many private health insurance plans cover lung cancer screening without cost-sharing, but eligibility criteria varies based on your plan. When booking your appointment, confirm with the facility that it and the providers are "in network" to avoid cost sharing. In Minnesota, Medicaid will cover CT screens for lung cancer.
Q: How are you addressing young people who smoke and vape?
A: During the 2020 legislative session, Minnesota raised the age to purchase all tobacco products to 21. As a member of the Smoke Free Generation Coalition, the Lung Association has a strong legislative agenda this session. We are working to increase the price of tobacco products, along with dedicating some of those dollars to prevention. We also are working to restrict access to all flavored tobacco products at the local and state level. With 78% of Minnesota's youth reporting the first tobacco product they tried was a flavored product, this is an important initiative.
Q: Does a lung cancer stigma persist that makes asking for help harder?
A: Stigma negatively affects every facet of lung cancer, including awareness, funding and support to patients and caregivers. Since smoking is the primary risk factor, people experiencing symptoms, including nonsmokers and never smokers, may not want to bring up questions with their doctor for fear of being denied treatment or the damaging perception that they brought it upon themselves. And there is fatalism on the part of some physicians as well, which may keep them from mentioning screening. The Lung Association is committed to understanding stigma and taking steps to address it.
Q: What are key risk factors?
A: Other than tobacco use, known risk factors of lung cancer include exposure to radon gas, air pollution, hazardous chemicals and secondhand smoke. If you experience persistent cough, coughing up blood, weight loss, back pain, or wheezing, talk to your doctor right away. Let your doctor know if you meet the high-risk criteria and are eligible for lung cancer screening. We encourage people to confirm their eligibility on our website (lung.org) and by using our doctor conversation guide at SavedbytheScan.com. We offer many resources and support groups to help you along the way.
Pat McKone, ALA senior director of public policy and advocacy, and Carly Ornstein, national director of lung cancer education, assisted in answering this week's questions.