Lung cancer remains one of the deadliest cancers, responsible for 1 in 4 cancer deaths in the US. Historically, it has been one of the most difficult to manage and cure. However, “the research story in lung cancer is an unbelievably positive one, Daniel Boffa, MD, professor of thoracic surgery at Yale School of Medicine, New Haven, Connecticut, and the vice chair for the American College of Surgeons Commission on Cancer, told Medscape Medical News. “The outcomes are much better than they ever have been.” Over the past 5 years, the survival rate has increased by almost 30%. “If you go back a decade, it’s almost doubled,” he said. 

This improvement is the result of the research effort in this field, which has led to major advances in surgery and personalized treatments, Boffa explained. Lung cancer screening with low-dose computed tomography (LDCT) and quitting smoking save lives. But too many still don’t access these services.

There are notable accessibility issues related to both lung cancer screening and smoking cessation programs, Maureen George, PhD, a pulmonary clinical nurse and a professor of nursing at Columbia University Irving Medical Center, New York City, told Medscape Medical News.

Screening Remains Largely Underused

The adoption of lung cancer screening with LDCT scans has allowed early diagnoses when treatments are easier on patients, and remission is much more likely. According to the National Cancer Institute, screening reduces deaths by up to 20%. Current guidelines recommend screening for adults aged 50 years or older who smoke or have smoked in the past. However, < 20% of eligible patients are screened every year, resulting in tens of thousands of preventable deaths. “Nobody wants to look for something they don’t want to find,” Boffa said.

Yet lung cancer screening is more effective than screening for other cancers, such as breast and colorectal cancers. For every 320 people screened for lung cancer, one life will be saved. According to Boffa, about 900 mammograms are needed to save one patient with breast cancer.

New research published in JAMA, based on the 2024 National Health Interview Survey, found that if all eligible individuals were screened, an estimated 62,000 lung cancer deaths could be prevented and over 870,000 life-years gained within 5 years. This represents an increase of more than 300% compared with current screening uptake levels. The analysis also revealed that nearly 30,000 potentially preventable deaths over 5 years occur in smokers who do not meet the 2021 US Preventive Services Task Force (USPSTF) screening criteria.

Accessibility issues are compounded by racial and socioeconomic disparities, meaning that the communities most burdened by lung cancer are often the most disenfranchised from care, said George. Several barriers can prevent people from accessing screening. These include insurance hurdles for LDCT scans, lack of trust stemming from past discrimination in healthcare, the scarcity of mobile screening units, and the logistical challenge of requiring transportation for people in low-income or rural settings. “Even if it requires a subway ride, which might seem simple to some people, but not for others, means those in rural settings who should participate in LDCT screening don’t,” she said.

George also pointed to a lack of inclusivity of the USPSTF recommendations, explaining that for communities of color, patterns of smoking mean they often develop lung cancer before the age of 50. Compounding this is the fact that people of color and those living in poverty face a “soup of exposures” — including poor air quality from ambient pollution and industry — that elevate their risk. Yet these environmental factors are not incorporated into screening criteria.

Recent research suggests that current eligibility criteria for screening inadequately identify high-risk populations, such as those with a genetic predisposition or other risk factors like exposure to certain chemicals and exclude approximately 50% of adults diagnosed with lung cancer. Every year, an estimated 20000 people who have never smoked die of lung cancer in the US. Moreover, approximately 4700 cases of lung cancer are diagnosed among adults younger than 50 years each year.

Quitting Smoking Saves Lives

Quitting smoking is the single most effective step to prevent lung cancer. It is also associated with better treatment outcomes, fewer complications, and can add up to 1.8 years of survival for patients with lung cancer. Quitting smoking is hard work, but the health benefits are well worth it, Boffa said.

Despite the prospect of better health, many people find quitting smoking an insurmountable obstacle. A lack of community-based resources and overburdened healthcare providers may make it difficult for patients to access or be referred to screening and smoking cessation programs, George said.

But “some people just don’t want to [quit smoking],” Katrina Roux-Bernstein, a nurse practitioner who specializes in pulmonology at the University of Maryland Baltimore Washington Medical Center, told Medscape Medical News.

Enjoyment and emotional associations with smoking are significant barriers. Effective cessation involves exploring these feelings and motivations through positive interviewing, helping patients examine what they enjoy about smoking and connecting it to their emotions, she said.

According to Roux-Bernstein, an effective program to help people quit smoking involves:

• A comprehensive, multi-pronged approach: This can include group classes and one-on-one counseling delivered either online or in-person to accommodate different needs and accessibility
• Use of medications and nicotine replacement therapies as appropriate
• Addressing both the physical (nicotine addiction) and psychological and emotional aspects of smoking
• Open and nonjudgmental communication: Creating a supportive environment where patients feel comfortable being honest about their smoking
• Step-by-step planning: Preparing patients mentally and emotionally for quitting, rather than simply prescribing a medication or telling them to stop
• Ongoing education and opportunities for patients to discuss their experiences, struggles, and motivations for quitting

When patients express enjoyment of smoking, Roux-Bernstein uses this as an opening to dig deeper: “It’s a great opportunity to open it up and ask them, ‘What about smoking do you enjoy? What specific emotion is there?’”

Through these discussions, patients sometimes realize that their morning cigarette, for example, doesn’t truly make them happy, prompting deeper insight and conversation about motivation and habits, Roux-Bernstein said.

She also emphasizes the use of positive language. This means taking what the patient says (even if negative or resistant) and reframing it in a more constructive, optimistic way, helping patients see new perspectives. “I frequently talk with patients about the benefits of quitting smoking, such as having better health, saving money, feeling less social stigma, and gaining their time back,” she said. 

She also encourages celebrating progress and focusing on positive reinforcement, for example, rewarding oneself with the money saved from not buying cigarettes, or recognizing immediate health improvements.

“There have never been better tools and support to help people quit,” said Boffa. “The benefits of quitting smoking should be a part of every encounter with the primary [care provider]. The benefits are tremendous, and it’s never too late.”

Boffa, George, and Roux-Bernstein reported no relevant financial relationships.

Manuela Callari is a freelance science journalist specializing in human and planetary health. Her work has been published in The Medical Republic, Rare Disease Advisor, New Scientist, The Guardian, MIT Technology Review, and others.