Lung cancer is the deadliest cancer in the U.S. – more people die of lung cancer than breast, colorectal and prostate cancer combined. And while it’s had its fair share of positive trends – cigarette smoking continues to decline, lung cancer deaths are slowly decreasing every decade – the overall numbers remain a source of concern: Almost 130,000 people died from lung cancer this past year. The most troubling part of this fact is, iit really doesn’t have to be this way.
If found at an early stage, lung cancer is treatable and survival rates are seven times higher. Our biggest problem is that only six percent of Americans who should get screened actually do. This is an abysmal number, and it looks even worse next to other cancers like breast, where closer to 75% of eligible women getting screened. On top of that, getting a lung scan (called a low-dose lung CT), is quick and painless. Unlike other cancer screening tests, you don’t have to drink any gross fluids or get sedated, a doctor doesn’t need to “check” your prostate, and you don’t have to endure getting your breasts smushed into pancakes.
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So why do so few eligible people go in for this painless, ten-minute lung scan?
Low screening adherence is often attributed to difficulty navigating the healthcare system. But when it comes to lung cancer, research shows that it’s more likely due to stigma. Or even worse, a fatalistic mentality that people have about being a current or previous smoker.
I spoke with a friend of mine – a 55-year-old married father of two who smoked at least 1-2 packs a day for over fifteen years. He quit in the mid aughts, but he knows that lung cancer is something he may face one day. He has never been screened, and in a recent conversation, told me: “What I did was stupid and I know the risk is there. But I feel fine now, so I’d just rather not think about it.”
I was flummoxed. Why? Why would he not take a quick test to ensure his lungs are healthy? After all, he quit almost two decades ago, so he’s already done the hardest part. In what other disease would you ever be so complacent? When would we ever just let a sickness play out, without doing everything in our power to prevent or stop it in its tracks?
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My friend proceeded to tell me that he knows he shouldn’t have smoked, it is one of his biggest regrets. He feels a sense of karma, that he consciously made the decision to smoke every day for many years, so he can’t really complain. Almost as if he deserved it. “I know I shouldn’t say this, but if I’m being honest, I enjoyed it. I was young, hard working and had an active social life. It was part of the culture and I opted in. So far I’ve been lucky. Maybe that means I’m out of the woods. Maybe not. I try not to think about it.”
Public perceptions of lung cancer is that it is a “smoker’s disease” — which also implies that those who get lung cancer “deserved” it, or that it was their “fault.” Let’s be honest, there is way less altruistic and optimistic attention paid towards lung cancer awareness and prevention — less galas, less fundraising walks, less celebrities wearing ribbons in solidarity. This, combined with a lack of education on the many factors that contribute to lung cancer risk, leads to self-stigmatization among those who currently or formerly smoked. It results in a fear of being denied treatment, concealment of their condition, and internal conflict which can deter individuals from seeking out lung cancer screening.
On top of that, the U.S. healthcare system doesn’t make it easy for those who do want to get screened. It can take weeks to get an appointment with a provider to get a referral for a CT scan, weeks to navigate your insurance coverage, and then weeks to find a nearby clinic and an appointment that works with your schedule. It’s annoying and time consuming. But there are things we can do to make it easier. Payers can make it easier for beneficiaries to understand their coverage and secure pre-authorization, clinics can digitize and automate their appointment scheduling processes, and employers — employers! — can provide time off and navigation support for their employees.
The new lung cancer screening guideline, announced by the American Cancer Society on November 1, encourages anyone aged 50-80, who currently or previously smoked heavily to get screened annually, no matter how long ago you quit smoking. We need to engage people who fall in these eligibility criteria, work with them to encourage them to get screened — without judgment. And let’s target those industries with higher smoking rates. According to research from the Centers for Disease Control and Prevention, mining (23.6%), real estate and rental and leasing (22.3%), construction (22.2%) and manufacturing (20.9%) have the highest smoking rates. We should be engaging people with the highest risk, using all the tools in our toolbox.
It’s high time we reframe how we think about lung cancer by ending the shame and judgment. I care less about if you quit smoking, I care more that you get screened. No one should have to die, period.
Photo: Mohammed Haneefa Nizamudeen, Getty Images
Alicia Zhou, PhD, Chief Science Officer Dr. Alicia Zhou is Color’s chief science officer and leads Color’s scientific affairs, medical affairs and medical operations teams. She received her Ph.D. from Harvard with a specific focus on cancer biology where her research spanned work at both the Dana-Farber Cancer Institute and the Broad Institute of M.I.T. and Harvard. She subsequently performed her postdoctoral work at UCSF. Dr. Zhou is a co-PI for the NIH’s All of Us Research Program Genetic Counseling Resource. At Color, she is responsible for driving Color’s scientific and research strategy, as well as managing the operations for Color’s medical group, and clinical services teams.
