Screening saves lives, but criteria too narrow

August 2, 2013 – 11:18 AM | By Amanda Pedersen | No comments yet

CTA few years back my brother-in-law Sam was starting a new job and was required to get a physical as part of the hiring process. A standard X-ray revealed a spot on his lungs and further testing confirmed it was cancer. The diagnosis came about two years after he’d quit smoking, but he had been a smoker for many years and was somewhere in his early 40s. Thankfully, because it was caught and treated so early, he is still with us today and doing great. But what if he hadn’t had that physical?
Earlier this week the U.S. Preventive Services Task Force issued a draft recommendation giving its second highest approval rating for routine CT screening for those at high risk for lung cancer. The grade B recommendation was widely applauded by advocacy groups such as the Lung Cancer Alliance, the American College of Radiology, and the Prevent Cancer Foundation. If approved in final form, the recommendation will trigger Medicare and insurance coverage and bring about a dramatic drop in lung cancer deaths. Experts say as many as 20,000 deaths a year could be prevented by screening.
Naturally my first thought when I heard about the recommendation was my brother-in-law and all the people like him who could be saved by this move.
But the recommendation only applies to current and former smokers age 55 to 80 with a smoking history the equivalent of smoking a pack a day for 30 years or two packs a day for 15 years. My brother-in-law would have been too young to meet that criteria at the time that he was diagnosed. How many other current and former smokers would slip through the cracks? How many of them could be saved by screening if the age range of the recommendation was widened?
I don’t claim to be an expert on lung cancer but it seems the criteria needs to be broadened. At least one advocacy group agrees. Legacy, a group that says it supports the task force recommendations but takes issue with some of the specifics, says the age range is too narrow.
According to the Lung Cancer Alliance, lung cancer takes 160,000 lives a year. Only 15% of people diagnosed with lung cancer will live five years or longer, primarily because the vast majority of lung cancers are diagnosed at a late stage. Sam was one of the lucky few, but he could have easily been one of the unlucky thousands, had it not been for that one physical that prompted additional screening.
Screening saves lives. The task force made an important decision when it issued its draft recommendation, but it would be even better if the minimum age for routine screening was lowered to 40.

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