Overcoming Barriers to Lung Cancer Screening

Lung cancer is the second most common cancer and the leading cause of cancer-related death in the U.S. Lung cancer screening via low-dose computed tomography (LDCT) is an accurate, fast and painless test covered by most insurance plans, yet less than 10% of people eligible for this test actually get screened.

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"Research shows that 80% of people who should be getting screened and are eligible to get screened have simply never heard of it [according to the American Lung Association]," says Chi-Fu Jeffrey Yang, MD, a Massachusetts General Hospital thoracic surgeon, head of the Yang Lab and founder of the American Lung Cancer Screening Initiative (ALCSI). "People from all walks of life have heard about mammograms and colonoscopies, but almost nobody knows what low-dose CT scans are or how they work. I think awareness is the biggest factor."

Lung Cancer Screening With Low-dose CT Scans

The U.S. Preventive Services Task Force recommends annual lung cancer screening for individuals meeting all the following criteria:

• Ages 50 to 80

• Have a 20-pack-year smoking history (1 pack/day for 20 years or 2 packs/day for 10 years)

• Currently smoke or quit within the past 15 years

The BMJ published a recent study by Dr. Yang and colleagues that estimates lung cancer screening has saved 10,100 lives since its implementation in 2014. These findings add to the wealth of research showing the success of lung cancer screening, including the National Lung Screening Trial and the NELSON trial.

For every 320 lung cancer screenings, one death is prevented—the fewest number needed to screen compared to other preventive tests, according to a study published in Cancer Epidemiology, Biomarkers and Prevention. Furthermore, LDCT radiation falls slightly above mammography and just below X-ray levels, making it a safe testing technique.

But despite LDCT's proven success and safety, the test has yet to reach its full potential in preventing lung cancer mortality. In addition to increasing awareness, Dr. Yang identifies four key misinformation hurdles that people must overcome to increase screening rates:

• Stigma about smoking and feeling like one deserves lung cancer

• Skepticism about whether lung cancer screening works

• Fatalism and the assumed inevitability of lung cancer and consequent death

• Fear of lung cancer screening costs and radiation risk

The American Lung Cancer Screening Initiative (ALCSI)

To combat misinformation, Dr. Yang founded the ALCSI in 2020. This volunteer-led organization raises awareness for lung cancer screening and works to increase access for high-risk individuals. Since its founding, the group has hosted more than 200 events and reached more than 10,000 people with lung cancer screening education. The ALCSI has developed a variety of initiatives, including a podcast.

ALCSI members also enable direct access to lung cancer screening. Sometimes that means partnering with local hospitals and medical centers to provide people with information about the closest center that offers screening. Other times, team members facilitate conversations between community members and their primary care provider via letter, email or phone call.

The ALCSI frequently collaborates with The White Ribbon Project, a nonprofit that promotes lung cancer awareness. Their joint events invite lung cancer survivors to create white ribbons (the ribbon of lung cancer) and pass them out to community members and healthcare providers to raise awareness.

"We would love to help other nonprofits, researchers and doctors with their efforts for lung cancer screening and awareness, smoking cessation and harm reduction," says Dr. Yang. "We really just want to help as many people as we can."

ALCSI Screening Advocacy

ALCSI team members also engage with public health departments, mayors, governors and senators on local and national advocacy efforts.

"In 2020, for the first time, the Senate passed a resolution expressing support for November as Lung Cancer Awareness Month and the early detection of lung cancer," says Dr. Yang. "This resolution started as a document on the laptop of one of our student leaders, Alex Potter. All 100 senators supported it with unanimous consent." Since then, more than 300 mayors and governors from all 50 states have issued proclamations on Lung Cancer Awareness Month.

The ALCSI team continues to achieve recognition of Lung Cancer Awareness Month for each new year and expand upon this annual resolution. The 2021 version included additional language addressing lung cancer in women and racial disparities in lung cancer treatment.

Lung Cancer Screening at Mass General

Mass General has a dedicated Lung Screening Program offering low-dose CT in multiple locations. Mass General screens the most patients for lung cancer in all of New England, according to the director of the Mass General Lung Cancer Screening Clinic, Jo-Anne Shepard, MD.

"Mass General has been a leader in lung cancer screening since the beginning. It's wonderful to be part of a team of doctors and staff that really cares about lung cancer screening," reflects Dr. Yang. He attributes Mass General's high screening rate to visionary leadership, along with great commitment and collaboration among departments.

Dr. Yang encourages healthcare providers to help patients figure out if they qualify for LDCT screening during office visits, especially yearly physicals and wellness visits. "Make lung cancer screening questions part of your regular practice," he implores. "Once people become more familiar with asking on a routine basis, the process shouldn't take much time at all."

Learn more about Mass General's Lung Screening Program

Visit the Mass General Cancer Center