Although science has proven that both men and women significantly benefit from lung cancer screening by low-dose CT, the NELSON study showed that women benefit substantially more than men.1 However, one of the reasons lung cancer screening is not recommended for everyone is due to the potential harm caused by the radiation exposure from low-dose CT. Although CT scans can detect lung cancer early, repeated exposure to even low-dose radiation can also cause lung cancer.
Presentation MA05.11, “Effect of lowering the starting age for lung cancer screening by low-dose computed tomography among women: a harm–benefit analysis,” analyzed the risks and benefits of lowering the screening age of women from 55 to 45.
This harm–benefit analysis demonstrates the benefits of lung cancer screening but warns of potential increased risks for women who begin annual screenings at a younger age. The authors suggest using an even lower radiation measurement to help offset the increased risk.
Although I applaud the study for its attempt to reduce the risk of radiation induced lung cancer, I have a greater concern regarding lung cancer screening.. Unfortunately, there are many people in the high-risk population already eligible for screening who are uninformed about the benefits of screening and lack access to screening. People who are at high risk for lung cancer, especially women, and who meet the criteria for screening are dying without ever being aware that screening is an option for them.
As a long-term patient advocate, I eagerly awaited the National Lung Screening Trial results.2 It seemed like an eternity before the U.S. Preventive Services Task Force recommended screening guidelines for people deemed high risk. I rejoiced when learning of proposed updates to those guidelines so more people could qualify for screening.
Ironically, despite a previous harm–benefit analysis predicting thousands of lives would be saved by lung cancer screening, we—as a society—have failed those who would benefit from screening.
I understand. Do no harm. Yet, there is a wide gulf between scientific theory and the reality of lung cancer taking more lives than breast, colon and prostate cancers combined. We have a long way to go before the pendulum swings in the direction of doing harm by screening too many people at high risk.
Once we reach our yet untapped potential for saving lives through screening, we will be well positioned to perfect our approach in maximizing the number of lives saved.
In my circle of friends, people are dying due to lack of knowledge about screening and lack of access to screening. Many others, who were not considered high risk yet have advanced lung cancer, wonder why there are no screening protocols for them.
Like many advocates, I watch and eagerly wait for scientists to discover a better way to screen for lung cancer, perhaps by a blood or saliva test. Until then, however, let us harvest the low hanging fruit of the many who would benefit from lung cancer screening now. Not doing so is the greater harm.
Read the post-conference digital WCLC News, to be distributed to all registrants and IASLC members 2 weeks after the conference, for coverage of this abstract.
- de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020; 382:503-513.
- National Cancer Institute website. National Lung Cancer Screening Trial. https://www.cancer.gov/types/lung/research/nlst. Accessed January 18, 2021.