Last week, the American Cancer Society (ACS) announced big changes to its lung cancer screening guidelines. As of November 1, five million more Americans who smoke or used to smoke should now get annual lung cancer screenings. The total number of eligible individuals has risen to 20 million. For most employers and unions, this means a larger percentage of your population will now need screening to have the best chance at catching lung cancer early, avoiding the devastating effects of a serious cancer on your employees and their families — and on your business.
The updated guidelines apply to anyone over age 50 and under age 80 who smoked 20 pack-years of cigarettes — the equivalent of one pack every day for 20 years, two packs daily for 10 years, and so on. Before the changes, screenings were recommended for a more narrow age range, 55 to 74, and people could stop screenings once 15 years had passed since they stopped smoking. New research shows that risk of lung cancer for those with a history of smoking continues to increase as they age — regardless of when they quit. This change is about guidelines finally catching up to clinical reality.
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What the updates mean for your employees or members
This is an important moment. Lung cancer will kill 127,070 people this year, but screening saves lives by catching the disease early. Adherence to screening dramatically changes the proportion of lung cancers caught at an early stage; in one study, adherence to screening guidelines caught 58.6% of lung cancer incidence at an early stage (stage IA or IB) compared to only 14.2% caught early without screening. Cancer diagnosed at an early stage has up to a 50 percentage point higher survival rate, and treatment costs about $240,000, or 38%, less. All someone needs to get screened is a doctor's order and an appointment at an imaging center for a low-dose CT scan (ldCT). The test takes about a minute, and it doesn't hurt.
Despite the millions of Americans who qualify for lung cancer screenings now, the issue is only about 6% get them. With the 'years since quitting' rule gone, your employees or members may be newly eligible for lung cancer screenings — or these guideline changes can serve as a reminder to check their eligibility in general.
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In addition to a lack of knowledge about screening, ACS research shows logistical barriers and stigma — especially for people who smoke or have smoked — get in the way of access to preventive care. It's not safe to assume people are hearing about their lung cancer screening eligibility from their insurance providers, and overburdened primary care providers are not consistently addressing cancer screening needs on their own. Updating clinician practices in line with the new guidelines can be a challenge; it takes time to change provider behavior. ACS has published research showing gaps persist despite providers' best intentions.
What employers can do to promote early detection of lung cancer
If everyone in the country followed these new guidelines, we could reduce lung cancer deaths by 21%. Even if we can catch disease earlier for a fraction of the 250,000 people diagnosed with lung cancer every year, we could save lives. Our country's employers — who provide healthcare benefits to about half of the U.S. population — can single-handedly reduce lung cancer deaths by helping their employees and members get screened.
As an example, based on current national adherence rates and the updated guidelines, an employer responsible for 20,000 lives would have 1,140 members eligible for screening — but only 70 of them would be up to date. This is a massive gap, and it contributes to high cancer costs and tragic outcomes. Exacerbating the issue is that plans do not report on lung cancer screening rates — so most employers don't understand just how serious an issue this is. Dedicated cancer prevention and screening programs help employers and funds navigate changing guidelines and get their people screened. The ACS and Color Health have partnered to do just this.
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Here's what cancer screening and prevention programs can do to help employers and funds improve early detection and reduce lung cancer deaths across the country:
1. Make sure employees are aware of their lung cancer risk factors and screening eligibility, based on updated ACS guidelines.
2. Support them in gaining referrals for and scheduling ldCT tests with in-network providers.
3. Assist them in navigating insurance coverage and any prior authorization requirements.
4. Coordinate follow up care based on screening findings as soon as possible.
5. Provide visibility and data on lung cancer screening rates in the workforce — often for the first time.
Lung cancer is the leading cause of cancer death in the U.S., but employers can change lives and save lives by making cancer screening access a priority in their plans and benefits design.
