Kentucky is a national leader in lung-cancer screening, but still has a long way to go to get all eligible people screened

American Cancer Society photo illustration

By Melissa Patrick
Kentucky Health News

Kentucky ranks second among states for lung-cancer screening, but experts say many more Kentuckians need to be screened. Only 10.6% of those at high risk have received screening; the national rate is 4.5%.

A recent study led by American Cancer Society researchers, published in the Journal of the American Medical Association Internal Medicine, shows fewer than one in five eligible individuals in the United States were up-to-date with recommended lung-cancer screening. 

"This research does show an improvement over screening rates reported for previous years. But we clearly, still have a long way to go. We must push harder to move the needle in the right direction,” Dr. Priti Bandi, ACS's scientific director for risk factors and screening-surveillance research, said in a news release.

The U.S. Preventive Services Task Force and ACS recommend annual low-dose CT scans for lung-cancer screening for individuals who:

• are 50 to 80 years old
• smoke or have quit smoking within the past 15 years
• have at least a 20 pack-year smoking history, which means a pack a day for 20 years or two packs a day for 10 years, and so on. A pack year is the number of packs smoked per day multiplied by the number of years the person smoked. 

Jennifer Redmond Knight, who serves as co-principal investigator for the lung-cancer screening project under the Kentucky Lung Cancer, Education, Awareness, Detection, Survivorship Collaborative, said one reasons lung-cancer screening remains low is because it is a relatively new cancer screening. The first recommendations for annual screenings were issued in 2013 and the eligibility for screenings expanded in 2021. 

"What that means is more people are now eligible for screening, which means the percentage of people who have been screened has gone down because there are more people eligible," Knight said. 

Another challenge is stigma, said Knight, who is also an assistant professor in the University of Kentucky's College of Public Health and a member of the UK Markey Cancer Center's Prevention and Control Research Program.

For years, Knight said people with a "significant smoking history" have felt shamed when their health-care providers ask them if they've quit smoking and they haven't, so when their provider encourages this new screening, there are often trust issues.

Knight said much work is being done in Kentucky to reduce stigma associated with lung cancer, largely through the Lung Cancer Screening Program the legislature created in 2022. Knight is on the program's advisory board.

"Kentucky is actually leading the way in many ways with quality lung-cancer screening and addressing the stigmas and helping lung-cancer screening programs throughout the state work in that space," Knight said.

She also talked about the value of early detection, which lets cancer be treated more effectively. Early screening is also important because it can often identify cancer before it spreads or causes symptoms. 

"We have hope now with lung cancer that we never had before," Knight said. "The story used to be if you get lung cancer, you're not going to make it very long. But now there's a story of hope that has to be changed. . . . So there's a lot of cultural shifts around this." 

The cancer society's research found that screening was much less common in persons without health insurance or a usual source of care, and in Southern states, which have the highest lung-cancer burden. Lung cancer is the leading cause of cancer deaths in Kentucky.

Most Kentuckians can pay for lung-cancer screenings through insurance or a program that offers low-cost screenings. Most Kentuckians have access to health insurance because the state expanded Medicaid in 2014, under the Patient Protection and Affordable Care Act, to include people making up to 138% of the federal poverty level. 

"If you meet the eligibility criteria, lung-cancer screening is covered by Medicare, Medicaid and most private insurance plans without cost-sharing. In rare instances where insurance coverage is unavailable, many programs including UK’s Lung Cancer Screening Program, offer screenings at a relatively low cost," Dr. Timothy Mullett of UK wrote in an article to debunk myths about such screenings.

The state Department for Public Health offers a service called Quit Now Kentucky to help Kentuckians of all ages quit smoking. To learn more go to QuitNowKentucky.org, text QUITKY to 797979 or call 1-800-QUIT-NOW.