Health
The deadly cancer hiding in plain sight — and why most patients never get screened
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A new study from Northwestern Medicine suggests that current lung cancer screening guidelines may be missing most Americans who develop the disease — and researchers say it’s time for a major change.
Published in JAMA Network Open, the study analyzed nearly 1,000 lung cancer patients who were treated at Northwestern Medicine between 2018 and 2023.
The goal was to see how many of those patients would have qualified for screening under existing guidance from the U.S. Preventive Services Task Force (USPSTF).
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USPSTF currently recommends annual CT scans for adults ages 50 to 80 who have a 20 pack-year smoking history (the equivalent of one pack of cigarettes per day for 20 years) and either still smoke or quit within the last 15 years.
Only about 35% of those diagnosed with lung cancer met the current criteria to undergo screenings.
Current lung cancer screening guidelines may be missing most people who develop the disease, a new study shows. (iStock)
That means roughly two-thirds of patients would not have been flagged for testing before their diagnosis.
“Not only does that approach miss many patients who had quit smoking in the past or did not quite meet the high-risk criteria, it also misses other patients at risk of lung cancer, such as non-smokers,” Luis Herrera, M.D., a thoracic surgeon at Orlando Health, told Fox News Digital.
The study noted that these patients tended to have adenocarcinoma, the most common type of lung cancer among never-smokers.
Missed patients tended to have adenocarcinoma, the most common type of lung cancer among never-smokers. (iStock)
Those missed by the guidelines were more often women, people of Asian descent and individuals who had never smoked, the study found.
The research team also compared survival outcomes. Patients who didn’t meet the screening criteria had better survival, living a median of 9.5 years compared with 4.4 years for those who did qualify.
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While this difference partly reflects tumor biology and earlier detection, it also highlights how current screening rules fail to catch a broad range of cases that could be treated sooner, according to researchers.
“The current participation in lung cancer screening for patients who do qualify based on smoking history is quite low,” said Herrera, who was not involved in the study. This is likely due to the complexity of the risk-based criteria and stigma associated with smoking and lung cancer, he added.
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To test an alternative, the researchers modeled a different approach: screening everyone between the ages of 40 and 85, regardless of smoking history.
Under that universal, age-based model, about 94% of the cancers in their cohort would have been detected.
Universal screening procedures could save lives and hundreds of thousands of dollars, according to the researchers. (iStock)
Such a change could prevent roughly 26,000 U.S. deaths each year, at a cost of about $101,000 per life saved, according to their estimates.
The study emphasized that this would be far more cost-effective than current screening programs for breast or colorectal cancer, which cost between $890,000 and $920,000 per life saved.
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Herrera noted the many challenges in the adoption of lung cancer screening, from lack of awareness to some providers not recommending the screening test.
However, he added, “The cost of screening is covered by most health insurance plans and many institutions also offer discounts for patients who don’t have insurance.”
“The current participation in lung cancer screening for patients who do qualify based on smoking history is quite low.”
Lung cancer remains the deadliest cancer in the country, killing more people each year than colon, prostate and breast cancer combined. But because of the narrow eligibility criteria based on smoking history, millions at risk never get screened.
Northwestern Medicine researchers argue that expanding screening to include all adults within an age range could help close those gaps, especially for groups often underdiagnosed.
Researchers argue that expanding screening to include all adults could help catch the missing cases. (iStock)
The study was conducted at a single academic center, which means the patient population may not represent the wider U.S. population. It also looked back at existing data, so it can’t prove how the new model would perform in real-world screening programs, the researchers acknowledged.
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The cost and mortality projections rely on assumptions that could shift depending on how screening is implemented.
The researchers also didn’t fully account for the potential downsides of broader screening, such as false positives or unnecessary follow-ups, they noted.
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For patients who don’t qualify for lung cancer screening, there are other opportunities for lung evaluations, including “heart calcium scores, CT scans and other imaging modalities that can at least evaluate the lungs for any suspicious nodules,” Herrera added.
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A new report by the American Heart Association (AHA) included some troubling predictions for the future of women’s health.
The forecast, published in the journal Circulation on Wednesday, projected increases in various comorbidities in American females by 2050.
More than 59% of women were predicted to have high blood pressure, up from less than 49% currently.
The review also projected that more than 25% of women will have diabetes, compared to about 15% today, and more than 61% will have obesity, compared to 44% currently.
As a result of these risk factors, the prevalence of cardiovascular disease and stroke is expected to rise to 14.4% from 10.7%.
The prevalence of cardiovascular disease and stroke in women is expected to rise to 14.4% from 10.7% by 2050. (iStock)
Not all trends were negative, as unhealthy cholesterol prevalence is expected to drop to about 22% from more than 42% today, the report stated.
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Dr. Elizabeth Klodas, a cardiologist and founder of Step One Foods in Minnesota, commented on these “jarring findings.”
“The fact that on our current trajectory, cardiometabolic disease is projected to explode in women within one generation should be a huge wake-up call,” she told Fox News Digital.
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“Hypertension, diabetes, obesity — these are all major risk factors for heart disease, and we are already seeing what those risks are driving. Heart disease is the No. 1 killer of women, eclipsing all other causes of death, including breast cancer.”
Cardiovascular disease is the leading cause of death for women in the U.S. and around the world. (iStock)
Klodas warned that heart disease starts early, progresses “stealthily,” and can present “out of the blue in devastating ways.”
The AHA published another study on Thursday revealing one million hospitalizations, showing that heart attack deaths are climbing among adults below the age of 55.
The more alarming finding, according to Klodas, is that young women were found more likely to die after their first heart attack than men of the same age.
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“This is all especially tragic since heart disease is almost entirely preventable,” she said. “The earlier you start, the better.”
Children can show early evidence of plaque deposition in their arteries, which can be reversed through lifestyle changes if “undertaken early enough and aggressively enough,” according to the expert.
Moving more is one part of protecting a healthy heart, according to experts. (iStock)
Klodas suggested that rising heart conditions are associated with traditional risk factors, like smoking, high blood pressure, high cholesterol, diabetes, obesity and a sedentary lifestyle.
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Doctors are also seeing higher rates of preeclampsia, or high blood pressure during pregnancy, as well as gestational diabetes. Klodas noted that these are sex-specific risk factors that don’t typically contribute to complications until after menopause.
The best way to protect a healthy heart is to “do the basics,” Klodas recommended, including the following lifestyle habits.
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Klodas especially emphasized making improvements to diet, as the food people eat affects “every single risk factor that the AHA’s report highlights.”
“High blood pressure, high blood sugar, high cholesterol, excess weight – these are all conditions that are driven in part or in whole by food,” she said. “We eat multiple times every single day, which means what we eat has profound cumulative effects over time.”
“Even a small improvement in dietary intake, when maintained, can have a massive positive impact on health,” a doctor said. (iStock)
“Even a small improvement in dietary intake, when maintained, can have a massive positive impact on health.”
The doctor also recommends changing out a few snacks per day for healthier choices, which has been proven to “yield medication-level cholesterol reductions” in a month.
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“Keep up that small change and, over the course of a year, you could also lose 20 pounds and reduce your sodium intake enough to avoid blood pressure-lowering medications,” Klodas added.
“Women should not view the AHA report as inevitable. We have power over our health destinies. We just need to use it.”
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