Dennis Schmidt started smoking as a teenager, when that was so unexceptional that his Catholic high school designated outdoor “senior smoking quarters,” where students in their final year could take cigarette breaks. He smoked a pack of menthols daily for nearly 40 years.
As a registered nurse at the University of Cincinnati Medical Center and a former Air Force medic, he knew this was a bad idea. “I made a couple of attempts to quit and they failed miserably,” said Schmidt, now 75.
Not until 2007 was he able to stop, using a newly approved prescription drug that reduced cigarette cravings. “I put them down and never went back,” he said.
Despite his years as a healthcare professional, Schmidt was unaware that lung cancer screening had become available for current and past smokers. The influential U.S. Preventive Services Task Force, an independent expert panel, recommended it in 2013.
Besides, he said, “I thought I was in the clear after all these years of not smoking.”
But in 2021, his primary care doctor, running down a list of questions at his annual Medicare wellness visit, asked whether he’d be willing to undergo a CT scan to detect lung cancer, and he agreed. A few days later, the results popped up on his patient portal: adenocarcinoma.
“It was stunning to read those words,” Schmidt recalled. “I knew what that was: cancer.”
Even with sharp declines in smoking, lung cancer remains the leading cause of cancer deaths in the United States, with 125,000 deaths estimated for this year, far exceeding fatal cases of colon, breast, or prostate cancer.
Yet in 2024, of the patients eligible for lung cancer screening, only about a quarter — or even fewer, depending on which data researchers analyzed — were up to date on the recommended annual scans.
“Abysmally low, especially because of how deadly lung cancer is,” said Chi-Fu Jeffrey Yang, a thoracic surgeon at Mass General Brigham and the senior author of a recent JAMA editorial about the screening rates.
Patients over 65 were more likely than younger people to be up to date. Still, only about a third were screened regularly, a far lower proportion than received other cancer screenings.
Screening has been shown to save lives. In 2011, a landmark clinical trial demonstrated that annual screening with low-dose CT scans reduced lung cancer deaths by 20% compared with the chest X-rays used previously.
More recent European trials have found far greater reductions. In 2019, Italian researchers reported that after 10 years, patients with six years of screening had a 39% decrease in lung cancer deaths compared with those who weren’t screened.
Why screening remains underused
Determining eligibility gets complicated. The task force, in a 2021 revision, recommended screening for those 50 to 80 years old with a “20 pack-year” smoking history who currently smoke or stopped within the past 15 years.
Both patients and doctors struggle with these criteria. Pack-year refers to how heavily someone smoked over time. Smoking a pack a day for 20 years creates a 20 pack-year history; so does smoking half a pack daily for 40 years.
The stigma attached to smoking probably also plays a role, sometimes making patients reluctant to disclose tobacco use. Screening rates also vary by state and insurance status.
Yet advances in treating lung cancer, including minimally invasive and robotic surgical procedures and increasingly effective drug therapies, mean that a diagnosis is “no longer a death sentence.” More than 80% of patients diagnosed in the earliest stages survive for five years or more.
For Schmidt, screening and treatment worked as intended. The mass found by his 2021 screening, diagnosed as stage 1 lung cancer, led to robotic surgery to remove the upper lobe of his right lung.
“It did what it was supposed to do,” Schmidt said of his screening. “I feel blessed.” He tends his extensive gardens in Bright, Indiana, flies kites, and goes camping with his grandchildren. He still works several shifts a month as a fire department paramedic.
This article is republished from KFF Health News under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.