by Beth Donovan | Special to the Courier

Fewer Americans are smoking cigarettes these days, and that’s a good thing since smoking is the leading factor contributing to the risk developing lung cancer. The next biggest factor is age.

Although treatments are becoming more effective over time and there are more options available, just over 20% of people with lung cancer will live longer than five years after diagnosis. So we still have a lot of work to do to find those cancers earlier when treatment is more effective.

It’s important to realize that even those who have kicked the habit are still at risk and, therefore, should be screened. Defining “smoker” can be a little tricky, but luckily some wise scientists looked at the data and determined for whom the benefit of screening outweighs the risk.

We measure the amount someone smokes using pack years. If someone smokes one pack, or 20 cigarettes per day, for one year, that would be one pack year. If you smoke a half a pack per day, it takes two years to get to one pack year. So, most people can calculate pretty quickly how much they have smoked in their lifetime. It is a little harder to add up pack years for social smokers or for those who have had multiple attempts at quitting, but an estimate is good enough. If you want to use a calculator, there is one available at mdcalc.com, search “pack years.”

The current recommendation is to screen smokers for lung cancer every year starting at age 50 and continue screening until 80 years of age. “Smoker” is defined as an adult who has a 20 pack year or more history of smoking who is still smoking or has quit within the last 15 years. The screening method is a low dose computed tomography, or CT scan, of the chest. The CT can identify potential abnormalities that a plain chest X-ray may miss. You can read more about screening from the National Cancer Institute at cancer.gov, search “lung cancer screening.” Screening rates for lung cancer, although recommended since 2016, remain relatively low compared to screenings for breast, cervical, and colorectal cancer.

Stopping smoking is the one lifestyle modification that can most drastically decrease your risk of developing lung cancer during your lifetime. Other risk factors exist, including exposure to second-hand smoke, a history of radiation therapy to the chest, some lung diseases, and a family history of lung cancer. If you feel like you might be at risk for development lung cancer, you should talk with your healthcare provider about those risk factors.

Since the enactment of the Patient Protection and Affordable Care Act, preventive screening tests as recommended by the United States Preventive Services Task Force, including screening for lung cancer, must be covered by most commercial plans with no cost to the patient. Medicare Part B also covers this service for adults who meet the smoking history criteria and are aged 50-77.

It’s a good idea to meet with your primary care provider at least annually to make sure you are up to date on preventive screenings and immunizations. If you think you should get screened for lung cancer, you’ll need an order from your healthcare practitioner. It is always a good idea to check with your insurance company to make sure that the service is covered as preventive, to ascertain whether a preauthorization is needed, and to get help choosing an approved radiology facility.

The US Preventive Services Task Force is a panel of preventive medicine experts who volunteer to review literature and clinical guidelines; develop recommendations for preventive screenings, medications, and counseling; and assign a grade to their recommendations. In 2021, the Task Force reviewed their previous recommendations from 2013 and expanded its recommendation in two ways: it changed the age to start screening from 55 down to 50; and changed to smoking criteria from a 30 pack year history to a 20 pack year history. This increases the number of adults eligible for screening as a preventive test. This recommendation was given a B grade, meaning that there is moderate net benefit. All grade A and grade B recommendations must be covered by most commercial health insurance plans with no cost to the patient.

You can download an app at uspreventiveservicestaskforce.org to learn which preventive screenings, medications or counseling services are recommended for you.

Claremont resident Beth Donovan, PA-C, practiced as a physician assistant for 20 years and served as chair of legislative affairs for the California Academy of Physician Assistants from 2004 to 2012. She is on the advisory board for Keck Graduate Institute’s Physician Assistant Program.