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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.
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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. About a fifth of lung cancer cases arise in people who never smoked, but smoking remains the most common cause, “even if the exposure happened much earlier in your life,” Bandi said.
Screening has been shown to save lives. In 2011, a landmark clinical trial demonstrated that annual screening with low-dose CT scans reduced lung cancer deaths by 20% compared with the chest X-rays used previously. That prompted the initial task force recommendation.