Lung Cancer Scan Saves Life Decades After Quitting Smoking

Dennis Schmidt began smoking during his teenage years, when the practice was so common that his Catholic high school provided designated outdoor smoking areas for seniors. He maintained a daily habit of one pack of menthol cigarettes for almost four decades.

Working as a registered nurse at the University of Cincinnati Medical Center and having served as an Air Force medic, he recognized the health risks. He attempted to quit several times, but each effort was unsuccessful, he recalled at age 74.

It was not until 2007 that he finally succeeded in quitting, employing a newly approved prescription medication that curbed nicotine cravings. “I set them aside and never resumed,” he explained.

Even though he spent his career in health care, Mr. Schmidt did not know that lung cancer screening had become accessible to current and former smokers. In 2013, the U.S. Preventive Services Task Force, an independent expert panel, issued a recommendation for such screening.

Moreover, he remarked, “I believed I was safe after all those years without cigarettes.”

In 2021, during his routine Medicare wellness examination, his primary care physician inquired about a low‑dose CT scan for lung cancer detection, which he agreed to. A few days later, his patient portal displayed the results: adenocarcinoma.

“Reading those words was shocking,” Mr. Schmidt recalled. “I immediately recognized the diagnosis: cancer.”

Despite significant reductions in smoking prevalence, lung cancer continues to be the foremost cause of cancer mortality in the United States, with an estimated 125,000 deaths projected for this year—surpassing combined fatalities from colon, breast, and prostate cancers.

In 2024, only roughly one quarter, or potentially fewer according to varying research analyses, of eligible individuals had undergone the recommended annual lung cancer screening.

“Abysmally low, particularly given the disease’s lethality,” remarked Dr. Chi‑Fu Jeffrey Yang, a thoracic surgeon at Massachusetts General Brigham and senior author of a recent JAMA editorial on screening rates.

Individuals older than 65 were more likely to be current with screening than their younger counterparts; however, only about one third underwent regular lung cancer screening—a stark contrast to the participation rates for other cancer screenings. Mr. Schmidt, for example, had consistently adhered to colonoscopy and prostate cancer testing for many years.

National registry data indicate that older adults experience markedly higher lung cancer risks. “Age is a universal risk factor for cancer,” noted Priti Bandi, an epidemiologist at the American Cancer Society. Seniors may also have accumulated many years of smoking exposure. Although approximately one fifth of lung cancer cases occur in never‑smokers, tobacco use remains the predominant cause, “even if the exposure occurred long ago,” Dr. Bandi added.

Screening has been proven to save lives. A landmark 2011 clinical trial demonstrated that annual low‑dose CT screening reduced lung cancer mortality by 20 percent compared with chest X‑ray screening, prompting the initial task force recommendation.

More recent European trials have shown even larger benefits. In 2019, Italian researchers reported that, after a decade of screening, participants who had been screened for six years experienced a 39 percent decrease in lung cancer deaths relative to unscreened controls.

Consequently, the question arises: why is screening still so underutilized? “Lung cancer screening is extremely simple, requiring only a two‑minute scan,” Dr. Yang explained. “You do not even need to wear a gown.”

One factor is the complexity of eligibility criteria. The task force, in a 2021 revision, recommends screening for individuals who (a) are aged 50 to 80, (b) have a cumulative smoking history of at least 20 pack‑years, and (c) either currently smoke or have quit within the past 15 years.

Both patients and clinicians find these criteria challenging to navigate. A “pack‑year” quantifies total tobacco exposure over time; for instance, smoking one pack daily for 20 years equates to a 20‑pack‑year history, as does consuming half a pack per day over 40 years.

Quantifying such exposure can be laborious, noted Dr. Teva Brender, a hospitalist at the San Francisco VA Medical Center and co‑author of a JAMA Internal Medicine article on lung cancer screening. “You might smoke a pack a day, then reduce to half a pack for two years, cease, and later resume,” she explained.

Stigma associated with smoking may also deter disclosure of tobacco use. As Dr. Yang observed, “Some people attribute blame to patients with lung cancer: ‘You caused this yourself by smoking,’” which can impede screening uptake. Moreover, screening rates differ by state and insurance coverage.

Nevertheless, advances in lung cancer treatment—including minimally invasive and robotic surgical techniques and increasingly effective pharmacologic therapies—have transformed a diagnosis from a death sentence into a manageable condition. “Survival rates have improved dramatically,” Dr. Bandi asserted.

Approximately 80 percent of patients diagnosed at the earliest stage survive at least five years, whereas survival declines sharply for later stages. Early detection through screening markedly improves these odds.

The New Old Age is produced through a partnership with KFF Health News.

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