by Paula Span, KFF Health News
Dennis Schmidt started smoking as a teenager, when that was so unexceptional that his Catholic high school designated outdoor “senior smoking quarters,” where students in their final year could take cigarette breaks. He smoked a pack of menthols daily for nearly 40 years.
As a registered nurse at the University of Cincinnati Medical Center and a former Air Force medic, he knew this was a bad idea. “I made a couple of attempts to quit and they failed miserably,” said Schmidt, now 75. Not until 2007 was he able to stop, using a newly approved prescription drug that reduced cigarette cravings. “I put them down and never went back,” he said.
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. Besides, he said, “I thought I was in the clear after all these years of not smoking.”
But in 2021, his primary care doctor, running down a list of questions at his annual Medicare wellness visit, asked whether he’d 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. “It was stunning to read those words,” Schmidt recalled. “I knew what that was: cancer.”
Even with sharp declines in smoking, lung cancer remains the leading cause of cancer deaths in the United States, with 125,000 deaths estimated for this year, far exceeding fatal cases of colon, breast, or prostate cancer.
Yet in 2024, of the patients eligible for lung cancer screening, only about a quarter — or even fewer, depending on which data researchers analyzed — were up to date on the recommended annual scans. “Abysmally low, especially because of how deadly lung cancer is,” said Chi-Fu Jeffrey Yang, a thoracic surgeon at Mass General Brigham and the senior author of a recent JAMA editorial about the screening rates.
Patients over 65 were more likely than younger people to be up to date. Still, only about a third were screened regularly, a far lower proportion than received other cancer screenings. Schmidt, for instance, had dutifully undergone colonoscopies and prostate cancer tests for years.
Data from national registries shows that older adults face sharply higher lung cancer risks. “Age is a risk factor for cancer generally,” said Priti Bandi, an epidemiologist at the American Cancer Society. But seniors may also accumulate more years as smokers.
Why does screening remain so underused? “Lung cancer screening is so easy, a two-minute scan,” Yang said. “You don’t even have to put on a gown.” One explanation: determining eligibility gets complicated. The task force, in a 2021 revision, recommended screening for those 50 to 80 years old with a “20 pack-year” smoking history who currently smoke or stopped within the past 15 years.
Both patients and doctors struggle with these criteria. Pack-year refers to how heavily someone smoked over time — smoking a pack a day for 20 years creates a 20 pack-year history, and so does smoking half a pack daily for 40 years. Calculating that number is time-consuming and “challenging,” said Teva Brender, a hospitalist at the San Francisco VA Medical Center.
This story was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. Learn more about KFF Health News.