"Making lung cancer screening as easy to get as a mammogram
Ultimately, the debate over lung cancer screening boils down to the limits of evidence. Barry said the task force’s criteria and the shared decision-making requirement are based predominantly on evidence from randomized controlled trials, the “gold standard” of clinical research. And previous trials for the low-dose CT scan have only included people with heavy smoking histories, thus showing a benefit in this population alone. “We can only look at what we have,” he said.
But critics argue that Barry’s approach neglects other important forms of evidence. For example, since 2001, Henschke has been running a research study in New York that’s opened up lung cancer screening to anyone age 40 or older, regardless of smoking history. The way it works is that patients worried about lung cancer, whether because of family history, secondhand smoke exposure, or some other risk factor, can talk to their doctor about lung cancer screening and get a referral. A trained nurse practitioner then has a one-on-one conversation with the patient about the risks and benefits, thus shifting the burden of shared decision-making away from the primary care physician and streamlining the process.
It’s not just Mount Sinai that’s taking this approach, Henschke said — her program is part of a larger consortium of 82 institutions in the International Early Lung Cancer Action Project (I-ELCAP). Since the project started in 1994, they have screened over 90,000 people, including 15,000 never-smokers, finding one lung cancer for every 240 never-smokers screened, compared to one lung cancer per every 70 smokers.
“Clearly, you’re going to find more lung cancers in people who have a greater smoking history,” but Henschke said that’s no excuse to ignore the 20,000 Americans who are dying from lung cancer every year despite never having smoked. Ultimately, her goal is to liberalize the lung cancer eligibility criteria, driving uptake through simplicity and greater access. She told STAT, “We don’t think a randomized trial is needed” to screen people over age 40 because I-ELCAP has shown that lung cancer screening can be safely implemented, with spillover benefits beyond lung cancer to the detection of emphysema, heart disease, and other serious conditions. “As long as you aren’t doing more harm than good, and you’re finding a good number of cancer cases,” Henschke said, then why not make lung cancer screening as easy to get as a mammogram?"