New Lung Cancer Screening Guidelines for Older Smokers

New guidelines recommending low-dose CT lung cancer screening for older age smokers have received approval by the US Preventive Services Task Force. The recommendations apply to people who are in the 55 to 80 age range and face a high risk for lung cancer due to a history of heavy smoking. The guidelines are reported in the journal Annals of Internal Medicine.

The US Preventive Services Task Force has released guidelines recommending CT lung cancer screening for older smokers.

What is the US Preventive Services Task Force?

The U.S. Preventive Services Task Force is an independent, volunteer panel of medical experts created in 1984. Their primary task is to make recommendations about clinical preventive services such as screenings, preventive medicine and counseling services.

The recommendations of the US Preventive Services Task Force are based on rigorous review of existing peer-reviewed evidence and are intended to help doctors and patients decide together whether a preventive service is right for a patient’s needs.

Each year, the Preventative Services Task Force makes a report to Congress. In this report they identify critical evidence gaps in research related to clinical preventive services and recommend priority areas that deserve further examination.

US Preventative Task Force Recommendations for Older Smokers December 2013

In December of 2013, based on the findings of the National Lung Screening Trial, the US Preventative Task Force made its recommendation for annual low-dose CT lung cancer screening. The recommendation was specific to adults between 55 and 80 years of age who have been smoking a pack a day for 30 years, and who either smoke currently or have quit smoking within the last 15 years. They also recommended that annual screening be discontinued once a person has more than 15 smoke free years, or in the event that they no longer have the ability or desire to undergo curative life surgery. This includes situations where there is dubious life expectancy.

The National Lung Screening Trial

The study that lead to this recommendation was the National Lung Screening Trial which compared the effectiveness of low-dose CT screening to chest x-rays. The results were impressive, with a 20% reduction in lung cancer deaths in the group that underwent CT scans.

The study was conducted from August 2004 to April 2004. There were 53,454 participants from 33 different U.S. medical centers, who were randomly selected to receive either CT scans or x-rays three times annually. The participants were between the ages of 55 and and 74 years old, and had smoked either one pack a day for 30 years, or two packs a day for 15 years. The group included those who had stopped smoking for 15 years or less.

Medicare to Cover LDCT Screening in Older Smokers Who Meet Criteria

Although there was some initial concern regarding the cost effectiveness of implementing widespread screening, and the relatively high rate of false-positives (20%), it was determined that the benefits of recommending annual screening exceeded any risks, and could be financially justified.

Based on this, the Centers for Medicare & Medicaid recommended an annual lung cancer screening with a CT scan be added as a preventative service benefit under the Medicare program, provided that the patient fit certain criteria.

The published criteria is lengthy and detailed, and intended as a guide for physicians, but a basic overview for smokers who may qualify includes the following:

You must be between the ages of 55 and 74 to qualify, and have a smoking history of a pack a day for 30 years. You must be a current smoker, or a person who has quit smoking within 15 years or less. A counseling session with your doctor is required in order for you to qualify. During this session you will receive information on the benefits of stopping smoking, as well as an opportunity to take advantage of programs and medicines your doctor may be able to provide to support you in the decision to stop smoking.  After the counseling session, your doctor will decide whether or not to make a written recommendation for you to receive annual screening, and determine if you meet all the qualifiers.

If you think you could benefit from annual screening, make an appointment with your healthcare provider to explore your options.

Cancer Risks for Older Smokers

The American Lung Association provides a wealth of information for older smokers. Smoking was much more prevalent in the 1960’s, when about 54% of adult males were smokers. By 2008 that number had dropped considerably to around 23% of adult male smokers. At that same time, over 17 million Americans over the age of 45 smoked, accounting for over 22 percent of all adult smokers, so the smoking rate of that generation remains high.

 

Unfortunately, chronic obstructive pulmonary disease (emphysema and chronic bronchitis) is highest among individuals over the age of 65. Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death, and is predicted to become the third by the year 2020. This is significant because smoking is directly responsible for more than 90% of COPD deaths.

Leading causes of death in individuals over 50 include coronary heart disease, stroke and lower respiratory tract infections– also frequently caused by smoking. In addition, 80-90% of lung cancer deaths are caused by smoking.

Its Never Too Late to Stop Smoking

There is a misconception that after a certain number of years smoking, or a certain age, that there is no positive benefit when you quit smoking. However, there is strong evidence that smokers who quit experience improved health and quality of life, no matter what age or how many years they have smoked.

Benefits of smoking cessation in older adults includes the following:

  1. Circulation improves immediately
  2. Lungs begin to repair damage
  3. Within one year of smoking cessation the risk of heart disease is cut almost in half.
  4. Within one year of smoking cessation the risk of stroke, lung disease and cancer begin to diminish.
  5. After the age of 65, men gain 1.4 to 2.0 added years of life.
  6. After the age of 65 women gain 2.7 to 3.4 added years of life.

While smoking cessation is always the ideal, If you are a heavy smoker between the ages of 55 and 74 years of age, you can reduce your risk of lung cancer death by 20% by having an annual low-dose CT screening. If you think you meet the criteria and would benefit from this service, call your doctor to arrange a consultation and discuss your options.

Sources:
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/lung-cancer-screening
http://www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/lung-cancer-screening
http://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=274

Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 1965-2006. Calculations for 1997-2006 were performed by the American Lung Association Research and Program Services Division using SPSS and SUDAAN software.

Centers for Disease Control and Prevention. Department of Health and Human Services. Health Consequences of Smoking: A Report of the Surgeon General, 2004.

Kerr S, Watson H, Tolson D, Lough M, & Brown M. Developing Evidence-Based Smoking Cessation Training/Education Initiatives in Partnership with Older People and Health Professionals. Caledonian Nursing & Midwifery Research Centre: Glasgow 2004

Taylor DH, Hasselblad V, Henley J, Thun MD, & Sloan FA. Benefits of Smoking Cessation for Longevity. American Journal of Public Health. 2002; 92:990-6.

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