The act of taking a deep breath is a simple, mindless reflex. However, for nearly 124,990 Americans this year, that same breath will become a reminder of a system that failed them. Currently, health care in the U.S. is viewed as a privilege, reserved for those who have the means to access it; it is no longer seen as a right. When it comes to lung cancer, our health care system creates a framework of “what ifs,” leaving patients with inoperable diagnoses and families with permanent scars. Why is this the case? We have the resources for screenings; however, the issue is who can actually benefit from it. Thoracic surgeons have the ability to perform the resections to treat early-stage disease, but many patients never make it to that point. They are often blocked by screening regulations that rely on outdated eligibility criteria, essentially removing the possibility of surgery before they even know they are sick.
The question is not whether screenings are actually beneficial. We already have seen that low-dose computed tomography (CT) screening reduces lung cancer mortality by 20 percent. However, insurance criteria that follow strict formulas keep “high-risk” populations from accessing this resource. Much of that failure begins with the definition of who qualifies as “high-risk.” Under the current U.S. Preventive Services Task Force (USPSTF) recommendation, routine lung cancer screening still depends heavily on a 20-pack-year smoking history and whether someone quit within the past 15 years. Given that most non-grandfathered private health plans are required to cover USPSTF-recommended preventive services, that “recommended” formula often becomes the real coverage formula patients face. For rural communities, that rigidity overlooks risk factors outside a smoking-history calculation, including higher residential radon exposure, which can raise lung cancer risk. If we want to make sure that coverage policies include everyone who is truly at high risk, we need to advocate for policy reforms that do so.
First, by 2028, the Centers for Medicare and Medicaid Services (CMS) and the USPSTF should expand the current eligibility criteria to account for external factors that simply cannot be captured by time. The federal government should mandate that all insurers transition from rigid pack-year limits to validated risk-based models like the PLCOm2012. By using models like the PLCOm2012, factors like racial health disparities, education levels, and family history can be considered. Rather than being exclusive to those who fit the current criteria, we can eventually widen the surgical pipeline for thousands of high-risk patients.
Second, by 2029, every Medicare- and Medicaid-participating health system that offers lung cancer screening should be required to track both the steps taken following an abnormal screen and the time patients wait. This should include the time it takes to see a specialist, to get a biopsy, and to reach surgery when it is needed. Every patient should have support navigating that process, including help with referrals and transportation when necessary. If delays are never measured, they are far too easy to ignore. It is in our hands as the next generation of not just providers, but as humans, to ensure that we are not taking shortcuts. Remember, a breath can be both a pleasure and a burden.
This article was written with the Center for Health Systems Innovation (CHSI).
Anuraag Balaji is an undergraduate student.
