Few People Are Being Screened for Lung Cancer as Recommended

“To improve lung cancer screening, the right people need to receive the right test.”

Thomas B. Richards, MD
Medical Officer in CDC’s Division of Cancer Prevention and Control
Lead Author

Lung cancer screening with low-dose CT is rarely used as recommended in the United States.

Lung cancer screening with low-dose computed tomography (low-dose CT) can find lung cancer early, when treatment may work better. In this test, an X-ray machine scans the body and uses low doses of radiation to make detailed pictures of the lungs.

The U.S. Preventive Services Task Force recommendsExternal yearly lung cancer screening with low-dose CT for people who—

  • Have a history of heavy smoking, and
  • Smoke now or have quit within the past 15 years, and
  • Are between 55 and 80 years old.

Heavy smoking means a cigarette smoking history of 30 pack years or more. A pack year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 30 pack-year history by smoking one pack a day for 30 years or two packs a day for 15 years.

A low-dose CT scan is the only X-ray test recommended for lung cancer screening. Chest X-rays are not recommended for lung cancer screening.

How the Study Was Done

CDC scientists looked at responses to the 2010 and 2015 National Health Interview Survey. They divided people who said they had received a lung cancer screening test into four groups—

  • CT scans (the right test) on people who met the screening criteria (the right person).
  • CT scans (the right test) on people who did not meet the screening criteria (the wrong person).
  • Chest X-rays (the wrong test) on people who met the screening criteria (the right person).
  • Chest X-rays (the wrong test) on people who did not meet the screening criteria (the wrong person).

What the Study Found

Appropriate Screening (The Right Test for the Right Person)

Only 4.4% (or 4 out of 100) of people who met the screening criteria said they got a CT scan for lung cancer screening.

Appropriate screening: Only 4 out of 100 eligible persons reported appropriate screening.

Inappropriate Screening

The number of people who were not screened as recommended for lung cancer is much larger than the number of people who were screened as recommended.

Inappropriate screening greatly exceeded appropriate screening. Right test on right person: 360,000. Wrong test on right person: 689,000. Right test on wrong person: 1,806,000. Wrong test on wrong person: 3,259,000.

People Eligible for Screening

As more smokers quit, the number of people who meet the lung cancer screening criteria is going down. The number of people who met the criteria fell from 9,620,000 in 2010 to 8,098,000 in 2015 (15%).

Population eligible for screening decreased 15% from 2010 to 2015.

What This Means

We need to find better ways to make sure that people who are at high risk of getting lung cancer because of their smoking history and age get screened as recommended.

Citation

Richards TB, Doria-Rose VP, Soman A, Klabunde CN, Caraballo RS, Gray SC, Houston KA, White MC. Lung cancer screening inconsistent with U.S. Preventive Services Task Force recommendations.External American Journal of Preventive Medicine 2019;56(1):66-73. DOI: 10.1016/j.amepre.2018.07.030.

Page last reviewed: February 11, 2019