Dennis Schmidt started smoking as a teenager, when that was so unexceptional that his Catholic high school designated outdoor \u201csenior smoking quarters,\u201d where students in their final year could take cigarette breaks. He smoked a pack of menthols daily for nearly 40 years. <\/p>\n
As a registered nurse at the University of Cincinnati Medical Center and a former Air Force medic, he knew this was a bad idea. \u201cI made a couple of attempts to quit and they failed miserably,\u201d said Schmidt, now 75.<\/p>\n
Not until 2007 was he able to stop, using a newly approved prescription drug that reduced cigarette cravings. \u201cI put them down and never went back,\u201d he said.<\/p>\n
Despite his years as a healthcare professional, Schmidt was unaware that lung cancer screening had become available for current and past smokers. The influential U.S. Preventive Services Task Force, an independent expert panel, recommended it in 2013.<\/p>\n
Besides, he said, \u201cI thought I was in the clear after all these years of not smoking.\u201d<\/p>\n
But in 2021, his primary care doctor, running down a list of questions at his annual Medicare wellness visit, asked whether he\u2019d be willing to undergo a CT scan to detect lung cancer, and he agreed. A few days later, the results popped up on his patient portal: adenocarcinoma.<\/p>\n
\u201cIt was stunning to read those words,\u201d Schmidt recalled. \u201cI knew what that was: cancer.\u201d<\/p>\n
Even with sharp declines in smoking, lung cancer remains the leading cause of cancer deaths in the United States, with\u00a0125,000 deaths estimated<\/a>\u00a0for this year, far exceeding fatal cases of colon, breast, or prostate cancer.<\/p>\n Yet in 2024, of the patients eligible for lung cancer screening,\u00a0only about a quarter<\/a>\u00a0\u2014 or\u00a0even fewer<\/a>, depending on which data researchers analyzed \u2014 were up to date on the recommended annual scans.<\/p>\n \u201cAbysmally low, especially because of how deadly lung cancer is,\u201d said Chi-Fu Jeffrey Yang, a thoracic surgeon at Mass General Brigham and the senior author of\u00a0a recent JAMA editorial<\/a>\u00a0about the screening rates.<\/p>\n Patients over 65 were more likely than younger people to be up to date. Still, only about a third were screened regularly, a\u00a0far lower proportion<\/a> than received other cancer screenings. Schmidt, for instance, had dutifully undergone colonoscopies and prostate cancer tests for years.<\/p>\n Data from national registries shows that older adults face\u00a0sharply higher lung cancer risks<\/a>. \u201cAge is a risk factor for cancer generally,\u201d said Priti Bandi, an epidemiologist at the American Cancer Society. But seniors may also accumulate more years as smokers. About a fifth of lung cancer cases arise in people who never smoked, but smoking remains the most common cause, \u201ceven if the exposure happened much earlier in your life,\u201d Bandi said.<\/p>\n Screening has been shown to save lives. In 2011,\u00a0a landmark clinical trial<\/a>\u00a0demonstrated that annual screening with low-dose CT scans reduced lung cancer deaths by 20% compared with the chest X-rays used previously. That prompted the initial task force recommendation.<\/p>\n More recent European trials have found far greater reductions. In 2019, Italian researchers reported that after 10 years, patients with six years of screening had a 39% decrease in lung cancer deaths compared with those who weren\u2019t screened.<\/p>\n Why, then, does screening remain so underused? \u201cLung cancer screening is so easy, a two-minute scan,\u201d Yang said. \u201cYou don\u2019t even have to put on a gown.\u201d<\/p>\n One explanation: Determining eligibility gets complicated. The task force, in\u00a0a 2021 revision<\/a>, recommended screening for those a) 50 to 80 years old with b) a \u201c20 pack-year\u201d smoking history who c) currently smoke or stopped within the past 15 years.<\/p>\n Both patients and doctors struggle with these criteria. Pack-year? It refers to how heavily someone smoked over time. Smoking a pack a day for 20 years creates a 20 pack-year history; so does smoking half a pack daily for 40 years.<\/p>\n Calculating that number is time-consuming and \u201cchallenging,\u201d said Teva Brender, a hospitalist at the San Francisco VA Medical Center and a co-author of\u00a0an article in JAMA Internal Medicine<\/a>\u00a0about lung cancer screening. \u201cYou might smoke a pack a day, then cut back to half a pack for two years, then stop. Then start again.\u201d<\/p>\n The\u00a0stigma attached to smoking<\/a>\u00a0probably also plays a role, sometimes making patients reluctant to disclose tobacco use. \u201cSome people blame patients with lung cancer: \u2018You did this to yourself because you smoked,\u2019\u201d Yang said. Screening rates also vary by state and insurance status.<\/p>\n Yet advances in treating lung cancer, including minimally invasive and robotic surgical procedures and increasingly effective drug therapies, mean that a diagnosis is \u201cno longer a death sentence,\u201d Bandi said. \u201cThe survival rate has improved dramatically.\u201d<\/p>\n More than\u00a080% of patients diagnosed in the earliest stages\u00a0of the disease survive for five years<\/a> or more, although survival drops sharply for more advanced cancers. And screening increases the odds of finding cancer early.<\/p>\n Frustrated that a potentially lifesaving tool remains so underused, some doctors and organizations are calling for changes in the Preventive Services Task Force recommendations, which lead to coverage by Medicare (Medicaid coverage varies by state) and many private insurers. \u201cThe screening guidelines are too restrictive,\u201d Yang said.<\/p>\n The American Cancer Society and the National Comprehensive Cancer Network have both\u00a0removed the 15-year requirement<\/a>\u00a0from their guidelines, which would make patients eligible for screening no matter how long ago they stopped smoking.<\/p>\n \u201cWe were disqualifying people from screening at a time when their risk was still rising,\u201d said Robert Smith, a screening expert at the society. He and his colleagues have urged the task force to also drop the 15-year stipulation,\u00a0submitting data<\/a>\u00a0to back their claim.<\/p>\n The\u00a0cancer network went further<\/a>, dropping both the 15-year and pack-year stipulations and advocating screening for anyone who smoked for 20 years.<\/p>\n The task force,\u00a0under fire<\/a>\u00a0from Health and Human Services Secretary Robert F. Kennedy Jr., hasn\u2019t responded to the American Cancer Society\u2019s analysis. Nor did it respond to a reporter\u2019s emails asking whether it planned to revise its lung cancer screening recommendations.<\/p>\n Expanding eligibility so that more people can undergo screening\u00a0could have downsides<\/a>, too. Some scans will reveal abnormalities that don\u2019t turn out to be lung cancer, but require additional scans (or, rarely, biopsies) and cause considerable anxiety. Even with low-dose scans, repeated screenings also involve some radiation exposure.<\/p>\n Moreover, a recent study showed that among older adults diagnosed with metastatic lung cancer,\u00a0fewer than half undergo treatment<\/a>. \u201cIf the public health goal is to reduce deaths from lung cancer through screening, it only works if you treat the people it identifies,\u201d said Steven Woloshin, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice.<\/p>\n For Schmidt, though, screening and treatment worked as intended. The mass found by his 2021 screening, diagnosed as stage 1 lung cancer, led to robotic surgery at the University of Cincinnati Cancer Center to remove the upper lobe of his right lung.<\/p>\n Surveillance scans followed every six months, then annually \u2014 until a 2025 scan revealed a small nodule in his lower lobe, another stage 1 cancer. Surgery removed that nodule, too. Schmidt now takes a targeted anticancer drug daily, a three-year regimen, while continuing regular scans.<\/p>\n \u201cIt did what it was supposed to do,\u201d Schmidt said of his screening. \u201cI feel blessed.\u201d He tends his extensive gardens in Bright, Indiana, flies kites, and goes camping with his grandchildren. He still works several shifts a month as a fire department paramedic.<\/p>\n Experts cautioned, however, that lung cancer screening and treatment cannot substitute for the benefits of stopping smoking \u2014 or never having started. \u201cThe risk is lower the longer you are away from cigarettes,\u201d Woloshin said. \u201cBut it doesn\u2019t go to zero.\u201d<\/p>\n The New Old Age is produced through a partnership with\u00a0<\/em>The New York Times<\/em><\/a>.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This article<\/a> first appeared on KFF Health News<\/a> and is republished here under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<\/p>","protected":false},"excerpt":{"rendered":" Dennis Schmidt started smoking as a teenager, when that was so unexceptional that his Catholic high school designated outdoor \u201csenior smoking quarters,\u201d where students in their final year could take cigarette breaks. He smoked a pack of menthols daily for nearly 40 years. 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