Current lung cancer screening guidelines, which focus on age and smoking history, are failing to identify a significant number of patients, particularly younger women and nonsmokers. Kara Goodwin, a 39-year-old marathon runner with no family history of cancer, was diagnosed with stage 4 lung cancer that had spread to her bones after experiencing persistent arm pain.
Her case, and others like it, highlight the limitations of current screening protocols. A recent study in JAMA Network Open found that a majority of lung cancer patients at Northwestern Medicine did not qualify for screening under existing guidelines.
Women, Asian Americans, and individuals who never smoked were more likely to be ineligible. This is occurring as lung cancer incidence is decreasing among smokers but increasing in other demographics, leading to a higher proportion of diagnoses in those who never smoked or who quit decades ago.
Experts suggest that expanding screening criteria could significantly improve early detection rates. Researchers propose that lowering the age threshold and reducing the smoking history requirement, or even implementing universal screening for adults within a certain age range regardless of smoking status, could catch the majority of cancers at earlier, more treatable stages.
However, concerns exist regarding unnecessary radiation exposure from low-dose CT scans and the potential for false positives with universal screening. While discussions about broadening screening guidelines are ongoing, some oncologists emphasize the need to improve uptake among those who currently qualify.
Despite challenges, including a lack of research funding, efforts are underway to conduct larger trials to identify patient populations that would benefit most from expanded screening. The case of Danielle Hoeg, who was diagnosed with stage 1 lung cancer on an unrelated MRI before her 44th birthday and had it surgically removed, demonstrates the potential for early detection and successful treatment when cancer is found incidentally.
