Lung cancer is the leading cause of cancer death in the United States. But updated screening … [+]
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Probably the second most common cancer and the leading cause of cancer death in the United States is falling numbers.
Yesterday, the U.S. Consecration Services Task Force (USPSTF) updated its recommendations in 2013 by warranting a systematic review of lung cancer screening accuracy using low-dose computed tomography (CT). They also measured the pros and cons of screening and determined the optimal age and duration for screening. The 2013 report recommended screening for adults ages 55 to 80 with a 30-year history of pack smokers who are currently smoking or have stopped in the past 15 years.
Last year, more than 228,000 people in the U.S. were diagnosed with lung cancer and ~ 135,000 Americans died from the disease. Overall, lung cancer has a relatively poor prognosis: the National Cancer Institute (NCI) reports the overall 5-year rate as 20.5% (versus 90% and 97.8% for breast and prostate cancer, respectively ). But if caught earlier, the prognosis improves as early-stage lung cancer is easier to treat.
Updated Suggestions
Eligibility for lung cancer screening, according to the USPSTF, includes people between the ages of 50 and 80 who have a 20-year history of smoking and are currently smoking or have stopped in those 15 years gone. Screening should be annual but discontinued when a person has not smoked for 15 years or develops a health condition that significantly reduces life expectancy or the ability to undergo medical lung surgery.
Imaging using low-dose radiation CT is an effective way to detect lesions in the lung.
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Lung cancer is not one disease
There are two main types of lung cancer: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), each with different prognoses and treatment regimens. NSCLC makes up 80-85% of all lung cancers and includes adenocarcinoma subtypes, squamous cells and large cell carcinoma. Treatment options include surgery (therapeutic, if taken early), chemotherapy and radiation. SCLC, which makes up 10-15% of all lung cancers, tends to spread faster than NSCLC and usually responds well to chemo- and radiation. Without treatment, SCLC has an aggressive course, with moderate survival from the date of diagnosis at two to four months. Find out more at NCI and the American Cancer Society (ACS).
The good news
The updated screening guidelines move a step closer to addressing differences in lung cancer detection among Black Americans and women. Both groups, according to the USPSTF, are likely to be non-heavy smokers and therefore may not have met previous guidelines for screening. One in five women diagnosed with lung cancer has never smoked, according to the Office of Women’s Health.
Patients at risk of lung cancer need to be identified by doctors and other healthcare providers … [+]
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The not so good news
Updates in lung cancer screening guidelines do not need to translate into better patient care. Research shows that half of the population eligible for screening is uninsured.
“The problem is that most eligible people don’t get screening because of a lack of insurance,” says Divya Bappanad, MD, a lung and emergency care physician at PeaceHealth who regularly prescribes CT screening. “There are a number of states where Medicaid does not cover low-dose screening, and the difference in mortality between early and late lung cancer is very large. ”
According to the ACS, Americans still have the highest mortality rates and lowest survival rates for most cancers, including lung cancer, among all racial or ethnic groups. decision. Changes in screening guidelines will only be effective if we overcome structural and systemic barriers including lower socio-economic status and reduced access to health care. In addition, some doctors and clinics may not recommend lung cancer screening as well as other preventative measures such as mammograms and colonoscopies.
Opportunity to tackle tobacco addiction
Tobacco is the leading cause of preventable death in the U.S., associated with almost all harms … [+]
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Not only is cigarette smoking the main risk factor for lung cancer but according to the Centers for Diesease Control and Prevention (CDC), it is the leading cause of preventable death in the US
“Smoking cessation reduces the risk of death, disability and many diseases, from addiction and cancer (bladder, colon, leukemia) to stroke and COPD,” explained Richard Saitz, MD, MPH, FACP, Chair of the Department of Sciences Community Health at Boston University School of Public Health.
But tobacco addiction (nicotine) is still under maltreatment. “Clinicians should use this accessible level to help patients stop smoking, regardless of the outcome of screening,” says Peter D. Friedmann, MD, MPH, DFASAM, Chair of Endowment for Clinical Research at Baystate Health.
The National Institutes for Drug Abuse (NIDA) approves a number of effective, evidence-based treatments, including behavioral and FDA-approved medications such as nicotine replacement (patches, lozenges, gum, inhalers, sprays), bupropion (“Wellbutrin”) and varenicline (“Chantix.”)
Harm reduction strategies should be used for individuals who are unwilling or unable to stop despite multiple attempts. Mobile interviews can also be effective in empowering people about their behavior by asking, ‘What do you like about smoking?’ and ‘Can you tell what life would have been different if tobacco was no longer a part of it?’
The COVID connection
Covid-19 disproportionately affects people with cancer, substance use disorders (ie drug / alcohol) … [+]
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Like most of life today, SARS-CoV-2 is involved. Studies show that people who smoke or have previously smoked are more likely to go into hospital or die from Covid-19 than non-smokers. As a result, the CDC has prioritized vaccines for smokers, fishing many who believe tobacco supplementation is an option. Important reminder: addiction is an infectious brain disease that impairs a person ‘s ability to control the use of substances, despite harming the user or those around them. There is NO sign of moral weakness or failure. Countless patients have told me that quitting smoking FAR was more difficult than quitting heroin or cocaine.
The Covid-19 pandemic has also highlighted and exacerbated pre-existing differences among marginalized groups. Joshua Barocas, MD, Infectious Disease Physician at Boston Medical Center: “Because there is an unequal burden of smoking-related illness among veterans, the homeless and those with comorbid medical and psychiatric illnesses , we must implement these protective health screening guidelines in all protected populations and improve access to care. ”