DiversityNursing Blog

Sandee LaMotte

"Our data raise questions about the current recommendations," said Mayo pulmonologist, Dr. David E. Midthun, one of the study authors. "We do not have the best tool to identify who is at risk for lung cancer."

Current U.S. Preventive Services Task Force guidelines recommend annual low-dose CT screening for adults age 55 to 80 who have smoked 30 pack-years (one pack a day for 30 years), and who currently smoke or have stopped smoking within the last 15 years. This criteria is used by doctors and insurance companies to recommend and pay for scans.

According to the researchers, the percentage of lung cancer patients who smoked at least 30 pack-years declined over the study period while the proportion of cancer patients who had quit for more than 15 years rose. 

"As smokers quit earlier and stay off cigarettes longer, fewer are eligible for CT screening, which has been proven effective in saving lives," said epidemiologist Dr. Ping Yang in a statement released by the Mayo Clinic Cancer Center. "Patients who do eventually develop lung cancer are diagnosed at a later stage when treatment can no longer result in a cure."

Over the study period the percentage of lung cancer patients who would have been eligible for CT screening under current guidelines fell dramatically: from 56.8% in 1984-1990 to 43.3% in 2005-2011. The proportion of men who would have been eligible decreased from 60% to 49.7%, while the percentage of women dropped from 52.3% to 36.6%. 

Researchers worry about the trend. "We don't want to disincentive patients to stop smoking," Midthun told CNN in a phone interview. "When I told one of my patients about the study, his first question was, 'If I stop smoking will I have to stop screening?'"

"We want people to stop smoking, and we don't want them to lie or continue smoking just so they can be screened," added Midthun. "We need better tools to make risk calculations for those who should be screened."

The Mayo study did not take into account other risk factors for lung cancer, such as personal and family history for lung cancer or Chronic Obstructive Pulmonary Disease (COPD) because they are not in the current guidelines for reimbursement. For example, COPD "raises a person's risk for lung cancer by four to six times," said Midthun, yet "only age and pack year history are in the guidelines."

"There's nothing magical in 30-year pack history," added Midthun. He told CNN that age is an equally important factor. "For example, if a person stops smoking at age 55, his risk of lung cancer at age 70 is higher than it was at age 55 when he quit."

The study was published in the February 24, 2015 issue of JAMA, the journal of the American Medical Association. It was funded by the Mayo Clinic and grants from the National Institutes of Health and the National Institute on Aging.

Source: www.cnn.com

Should the legal age for smoking be raised from 18 to 21? That’s the question being pondered by lawmakers in California, where a growing contingent of health advocates are seeking to make their state’s minimum smoking age the highest in the United States.

Known as Bill 151, the legislation, which was proposed by Democrat Senator Ed Hernandez last Thursday, is designed to limit tobacco smoking among young people. Hernandez says it’s about preventing people from becoming addicted to cigarettes when they’re most vulnerable.

“Tobacco companies are aware that people tend to become addicted to smoking if they start it at young age,” Hernandez said. “Senate Bill 151 proposes to increase the legitimate smoking age in California from 18 to 21 years in an offer to restrain tobacco smoking in children and teenagers.”

Hernandez has evidence to support his cause. According to the American Lung Association, nine in ten smokers take up the habit right around the time they reach age eighteen. Overall, it’s estimated that about 36,000 California children begin smoking each year.

Hernandez says it’s time to take a tougher approach when it comes to preventing young people from smoking. “We can no more bear to sit on the sidelines while huge tobacco markets to our children and gets another era of youngsters snared on an item that will at last kill them,” Hernandez said.

California is not the first state to make this venture. Utah, New Jersey, Maryland, and Colorado have all tried to raise the smoking age from 18 to 21, with every attempt ending in failure.

Source: www.activebeat.com