Lung cancer is the leading cause of cancer death worldwide. The deadliness of the disease can be partially attributed to the late onset of symptoms, often resulting in late diagnosis. In fact, 70 percent of lung cancer cases are discovered in advanced stages.
Despite growing awareness among physicians about the value of screening to identify lung cancer earlier, there are still knowledge gaps regarding the latest developments in screening technology and which at-risk groups need to be screened. Many incorrectly assume that testing only the highest-risk individuals – aging smokers – is sufficient. However, other groups, such as those with a family history of lung cancer or significant exposure to air pollution or radon, should also be screened. Ensuring that all doctors, including those outside top academic centers, are knowledgeable on the best practices and understand the value of lung cancer screening in all at-risk populations will allow us to identify patients earlier and provide them with potentially life-saving treatment.
Over the past few years, CT screening for lung cancer has emerged as the standard clinical practice. 
While there are a few potential harms, they must be weighed against its great potential to diagnose lung cancer patients in earlier stages. More screening methods are emerging too, such as screening with spiral CT scans and an approach that can detect cancer cells in sputum samples. Especially when used in conjunction with advanced treatment methods – such as the use of biomarkers, targeted therapy and immunotherapy – screening can lead to more favorable outcomes and innumerable lives saved.
While the latest guidelines recommend screening only the highest-risk population, research points to increasing rates of lung cancer in never-smokers and highlights other clear factors indicating someone should be screened.
Annual CT screenings for high-risk individuals reduce the relative risk of death from lung cancer by 20 percent. However, only those at the highest-risk are currently being screened regularly. The American College of Chest Physicians 2017 screening guidelines recommend annual low-dose CT screening for asymptomatic smokers and former smokers aged 55 to 77 years, who have smoked 30 pack-years or more and either continue to smoke or have quit within the past 15 years. While these guidelines support screening the highest-risk groups, they go on to recommend not regularly screening at-risk groups that do not fall within these specific descriptors. This excludes other at-risk groups that could greatly benefit from screening.
So the question remains – who should be screened?
While the latest guidelines recommend screening only the highest-risk population, research points to increasing rates of lung cancer in never-smokers and highlights other clear factors indicating someone should be screened. The proportion of non-small cell lung cancer (NSCLC) patients in the U.S. who were never-smokers increased from 8 percent between 1990 and 1995 to 14.9 percent between 2011 and 2013. This may be due to a number of factors known to cause lung cancer, including inherited genetic mutations, air pollution, radon, asbestos and others. For those with a family history of lung cancer, there are tests for these specific gene mutations and treatments that can prevent the onset of cancer for many years. However, this population often falls through the cracks when it comes to screenings, as they don’t fit in the recommended, highest-risk group.
The results of a study presented at the International Association for the Study of Lung Cancer 18th World Conference on Lung Cancer highlight rapid advancements in lung cancer treatment. Its results showed that the median overall survival for patients diagnosed from 2010 to 2013 (14.8 months) was significantly higher when compared to patients diagnosed from 2004 to 2009 (12.4 months). However, the increase is driven primarily by academic centers that have taken a comprehensive approach to screening, which fosters greater success in early detection and effective treatment.
The study also highlighted that NSCLC treatment at academic centers was associated with reduced risk of death when compared to non-academic centers. While these developments have profound potential, the fast pace of lung cancer research has created a lack of awareness and knowledge among many doctors, especially in non-academic settings. Better education about the availability of these tests, the proper equipment, who to screen and how to follow-up with additional testing and treatment is critical to capitalizing on these advancements. With improvements in screening methods and increased treatment options, it’s become possible to target the disease in earlier stages when it is more treatable, but only for those who have the knowledge and resources necessary.
With never-smokers comprising approximately 20 percent of people who die from lung cancer annually in the United States, we cannot neglect this population of non-smokers who may have other indicators of high-risk for lung cancer. We must increase access to testing resources and increase the populations we test. Doctors in any medical setting, including both academic and community centers, need to know who the at-risk lung cancer populations are and have resources to screen and treat these patients, or be able to refer them elsewhere if resources aren’t available.
Advancements in lung cancer research and treatment can’t make a full impact until everyone has access to doctors and hospitals that know how to use the newest resources.
In order to make lung cancer a more manageable and less deadly disease, it is essential that we close this knowledge gap.
Last Editorial Review: January 11, 2017
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