About Lung Cancer

In 2021, the American Cancer Society estimated that 235,760 new cases of lung cancer will be diagnosed in the United States. Lung cancer is the second most common cancer diagnosed in both men and women. Yet, it is the leading cause of death by far, with an estimate that 131,880 people will die from the disease in 2021.

Lung cancer mortality has declined by 54% since 1990 in men and by 30% since 2002 in women due to reductions in smoking, with the pace accelerating in recent years; from 2014 to 2018, the rate decreased by more than 5% per year in men and 4% per year in women.

Cigarette smoking is by far the most important risk factor for lung cancer, with approximately 80% of lung cancer deaths in the United States still caused by smoking. Risk increases with both quantity and duration of smoking. Cigar and pipe smoking also increase risk. Exposure to radon gas, which is released from soil and can accumulate in indoor air, is the second-leading cause of lung cancer in the United States. Other factors associated with increased risk include exposure to secondhand smoke (2.7% of new cases, the equivalent of 6,400 in 2021), asbestos (particularly among individuals who smoke), certain metals (chromium, cadmium, arsenic), some organic chemicals, radiation, air pollution, and diesel exhaust. Specific occupational exposures that increase risk include rubber manufacturing, paving, roofing, painting, and chimney sweeping.

In a large U.S. clinical trial, screening with low-dose computed tomography (LDCT) reduced lung cancer mortality by about 20% compared to standard chest x-ray among individuals who currently smoke or individuals with a smoking history (quit within 15 years) of at least 30 pack-years. Based largely on this information, the American Cancer Society issued guidelines in 2013 recommending annual lung cancer screening for individuals who currently smoke or individuals with a smoking history of at least 30 pack-years, who are aged 55-74 and are in relatively good health and have undergone evidence-based smoking cessation counseling and a process of shared decision making with a clinician that included a description of the potential benefits and harms of screening. Recently, two European trials reported even larger mortality reductions for screening among a more moderate risk pool. In March 2021, the USPSTF released an update of their 2013 recommendation statement for annual screening for lung cancer with LDCT. The updated recommendation retains the Grade B recommendation. Under the Affordable Care Act, or as it’s commonly known, the ACA, Grade A & B recommendations must be covered by most private health insurance plans and Medicaid expansion with no out-of-pocket costs. For more about the USPSTF Grade Definitions, please visit: Link

The updated criteria included:

• Adults aged 50 to 80 years
• Individuals who have at least a 20 pack-year smoking history and currently smoke or have quit within the past 15 years
• Screening should be discontinued once an individual reaches age 80, has not smoked for 15 years, or develops a health problem that may limit life expectancy or the ability or willingness to have curative lung cancer surgery

The USPSTF’s full recommendation statement can be found here: Link