University of Iowa joins top cancer centers in urging more lung cancer screening

IOWA CITY — An estimated 6,300 Iowans died of cancer this year, and the type that took the most lives — at nearly a quarter of the total — was lung cancer, making it the deadliest in both Iowa and the United States.

Nearly tripling the 540 deaths from Iowa’s second-deadliest cancer in 2022, colon and rectum, lung cancer is so fatal partly because of the low screening rate, allowing the disease to advance to a stage of only limited treatment options.

Given that low-dose CT scans are available and capable of detecting lung cancer early, the University of Iowa’s Holden Comprehensive Cancer Center recently joined more than 50 top cancer organizations in urging providers and insurers to improve access to and more frequently use lung cancer screening tools for those at high risk.

“Unfortunately, the evidence indicates that only 5.7 percent of Americans considered high-risk for developing lung cancer had a recent … screening exam,” according to a collective “call to action” letter — signed by Northwestern Medicine, Emory Winship Cancer Institute and the National Comprehensive Cancer Network, among others.

And that dismal lung cancer screening rate was pre-pandemic. It compares with screening rates for breast, cervical and colon cancer hovering between 60 and 80 percent.

“About 8 million Americans qualify as high risk for lung cancer and are recommended to receive annual screening with low-dose CT scans,” according to the American Lung Association. “If half of these high-risk individuals were screened, over 12,000 lung cancer deaths could be prevented.”

‘Work to be done’

Nationally, like in Iowa, lung cancer accounts for about 25 percent of all cancer deaths and in 2018 — the most recent data available — killed an estimated 154,050 Americans. It’s the leading cancer killer in both men and women, surpassing breast cancer to become the most deadly for women in 1987.

Only 16 percent of lung cancer cases are diagnosed at an early stage, and more than half of people with lung cancer die within a year of discovery, according to the lung association.

The U.S. Preventive Services Task Force first issued lung cancer screening guidance in 2013 and last year expanded eligibility to include in its “high-risk group” anyone 50 to 80 years old who currently smokes or used to at a 20-pack-a-year rate or more.

That guidance lowered the recommended screening age from 55 and dropped the minimum smoking history from 30 packs a year.

And while Iowa’s 11-percent lung cancer screening rate is double the national figure, UI Health Care officials urged the state must do better.

“Even though Iowans are being screened for lung cancer at higher rates than the rest of the country, there is still much work to be done to improve access to screening for high-risk populations and reduce the lung cancer mortality rate,” university officials said.

Breaking down barriers

A 2022 Cancer in Iowa report found just one in four of this state’s lung cancer cases is diagnosed at a localized stage.

“Early detection is key to reducing lung cancer mortality,” according to the national call-to-action letter. “However, several barriers significantly inhibit participation.”

Those include discrepancies in state Medicaid coverage for lung cancer screening; challenges identifying, enrolling and navigating the screening system; provider, patient and community lack of awareness; and deficient health system screening incentives.

Support on a national level could address those barriers, beginning with educational campaigns, according to the letter.

“Although there are national public awareness campaigns for tobacco cessation, campaigns focused on lung cancer and lung cancer screening have been limited by comparison, resulting in broad unfamiliarity with the value of lung cancer screening among the target population and health care providers,” according to the call-to-action.

Public awareness campaigns about lung cancer screening should use non-judgmental language to share practical information, like eligibility, cost and coverage; details on how to access lung screening; and facts on ways screening can increase survival rates.

The letter also suggested addressing systemic inequities in health care availability, noting “smoking rates are highest among the uninsured.”

“Increasing access to comprehensive health insurance coverage can help ensure people who smoke have access to both tobacco cessation treatments and, if eligible, lung cancer screening,” according to the letter.

Although high-risk Americans insured through Medicare, private insurance or Medicaid expansion now have access to free annual lung cancer screening, states aren’t required to cover it for traditional Medicaid patients — meaning “gaps in coverage remain.”

“We urge every state’s Medicaid program to provide coverage for tobacco cessation and annual lung cancer screening and call on all insurers to eliminate barriers,” according to the letter.

The cancer entities in their message urged lawmakers and leaders to invest in lung cancer screening sites, develop quality metrics for lung screening and regulate it.

“Together, we can make real and meaningful reforms to ensure that high-risk individuals across the nation have access to lung cancer screening.”

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