Study: Fewer Than 1 in 5 Eligible Americans Are Getting Screened for Lung Cancer

A new study published in JAMA shows that American lung cancer screening rates are far less than ideal. Researchers from The American Cancer Society identified that less than one in five Americans who are at a high risk of developing lung cancer are hitting the optimal yearly testing schedule.

Those at high risk include people 50–80 years old who smoke or smoked a pack a day for 20 years. People who quit smoking less than 15 years ago are still considered high-risk. The goal is for those at high risk to be tested every year via a CT scan.

The United States Preventive Services Task Force (USPSTF) implemented screening recommendations in 2014. Prior to that, the task force said there was insufficient evidence to recommend for or against screening.

Priti Bandi, PhD, one author of the study who serves as a scientist director for risk factors and screening research with the American Cancer Society, says that the study fills in some data gaps about how well the screening guidance is working.

“Fast forward a decade [after the recommendation change], we know very little about what the uptake is of this screening in the population of U.S. adults,” Bandi told Verywell. “That’s because these large national surveys that we use to track this behavior have not measured lung cancer screening very well over time.”

That research landscape shifted in 2022 when a national survey of health-related risk behaviors started asking a question about lung cancer screening to survey respondents in all states.

Bandi said previous research indicated that lung cancer screening rates within this high-risk population group were between 6.5% and 15% in 2020. That number has bumped up to 18.1%. While Bandi said this jump was a “pleasant surprise” to her and her team, the marked difference between states is still a problem. For example, better screening rates in the northeast are responsible for much of the increased national average.

Calculating screening rates is vital because early detection makes a significant difference in lung cancer mortality.

“We know lung cancer is still the leading cause of [cancer-related] death in the U.S.,” she said. “We also know that intervening when it’s an early stage is associated with markedly better survival. Lung cancer screening is essentially an early detection tool. When you find cancer early, you can prevent cancer death.”

When identified at a local stage, non-small cell lung cancer has a five-year survival rate of over 60%, compared to just 8% when diagnosed at a distant stage.

Why Are Testing Rates So Low?

According to estimates made by the National Cancer Institute, 11.7% of all cancer cases and 20.4% of all cancer deaths this year will be due to lung cancer. So why are testing rates so low? Fernando Santini, MD, a thoracic oncologist at Memorial Sloan Kettering Cancer Center, said it’s a combination of factors.

“The first big hurdle and challenge is to find those patients and to really educate them to do the CT scan. The second hurdle is finding somewhere to do that,” Santini told Verywell. “Then you have the problems of insurance and reimbursement.”

Bandi agrees that it’s not as simple as telling people they need to go in for a scan. There are structural concerns that also need to be addressed.

“You need dedicated facilities and capacity. This doesn’t just include the actual infrastructure of the buildings, but also the physicians are trained to read these radiologic images,” she said. “It’s much better than before, but it’s not to the point where we can just scale it out to the entire population.”

Geographical and Regional Differences

Half of the 10 states that have not implemented Medicaid expansion have drastically lower annual lung cancer screening rates compared to the rest of the country: Georgia, Mississippi, Tennessee, Texas, and Wyoming.

The state with the highest percentage of people up to date with their screening is Rhode Island at 31%. The lowest was Wyoming, with 9.7%. Santini said that lung cancer screening via a CT scan is also important because it can be a way to identify other health conditions.

“For any policy makers, the message is we need state-based and national efforts to improve access to comprehensive cancer screenings, including lung cancer screening,” Bandi said.

The benefits of annual CT scans for smokers extend beyond lung cancer detection.

“While the main purpose is to look for lung nodules, a CT scan can also help identify lung disease like COPD or coronary calcification,” Santini said. “You need to get the most out of these visits.”