Many medical organizations have been recommending lung cancer screening for decades for those at high risk of developing the disease.

But in 2022, less than 6% of people in the U.S. eligible for screening actually got screened. Compared with other common cancer screenings, lung cancer screening rates fall terribly behind. For comparison, the screening rate in 2021 for colon cancer was 72%, and the rate for breast cancer was 76%. Why are lung cancer screening rates so poor?

I am a pulmonologist who specializes in screening and diagnosing lung cancer. In my research to improve early detection of lung cancer, I’ve found that numerous complex barriers hinder the widespread adoption of lung cancer screening.

Basics of lung cancer screening

Lung cancer is the leading cause of cancer-related death in the world. But early detection can significantly improve outcomes.

Survival rates for early stage lung cancer are nearly seven times higher than lung cancer that has spread in the body. Between 2015 and 2019, survival rates for lung cancer have improved by 22%, in part because of an increase in earlier diagnosis.

Most patients with early-stage lung cancer, however, have no symptoms and aren’t diagnosed until they reach more advanced stages that are harder to treat, underlining the need for effective lung cancer screening.

The U.S. Preventive Services Task Force recommends lung cancer screening for people 50-80 years old, people who currently smoke or previously smoked but quit within the past 15 years, and people who smoked at least 20 pack-years. Pack-years is an estimate of cigarette exposure in a person’s lifetime, calculated by multiplying the total number of years someone has smoked by the average number of packs smoked per day. For example, if someone smoked half a pack per day for 40 years, they would have smoked for 20 pack-years.

Low-dose CT scan for lung cancer

One of the primary barriers to lung cancer screening is lack of public awareness and understanding. Many people are unaware they qualify for lung cancer screening or have misconceptions around what to expect from the screening process.

Lung cancer screening involves a yearly low-dose computed tomography, or CT, scan, a diagnostic imaging tool that uses X-rays to create detailed cross sections of the inside of the body. Screening 250 patients can prevent one lung cancer death. In comparison, 645 people screened with a mammogram can prevent one breast cancer death.

Some people have reservations surrounding the scan itself because of radiation exposure. The radiation from a low-dose CT scan, however, is about 1.4 millisieverts – the scientific unit used to measure ionizing radiation – which is less than the 3 to 5 millisieverts of background radiation a person may be exposed to in a given year on average while living on Earth.

The whole process takes only a few minutes and does not require any needles, medications or infusions. During the scan, the patient lies on the scanner’s sliding table and raises their arms above their head. The technologist may ask them to hold their breath for 5 to 10 seconds as the table passes through the scanner.

A radiologist summarizes the results of the test for their doctor in a report. If the result is negative for findings in the lungs, the patient would return in one year for another scan. If the result is positive, it usually means the radiologist saw a lung nodule, or a spot on the lung. Not all lung nodules are cancer, and patients may require additional imaging or a biopsy to confirm.

Disparities in lung cancer screening

Public health campaigns and education initiatives work to engage the public and increase awareness of the availability and benefit of lung cancer screening. However, these efforts have been less effective in some of the communities most at risk for developing lung cancer.

African American men have the highest rates of developing and dying from lung cancer compared with other groups, even at younger ages and among those with less smoking history. The tobacco industry has explicitly targeted the Black community with pervasive marketing tactics in predominantly Black neighborhoods and stores. Since the 1970s, the tobacco industry has aggressively marketed menthol cigarettes to African Americans using tailored messaging and imagery. This compounds and exacerbates the socioeconomic disparities in health care and cancer care already seen in these underserved and underrepresented communities.

Rural communities face geographic barriers to lung cancer screening. About 80.5 million Americans live in counties with high rates of lung cancer and poor access to a quality screening center. Many of these counties are clustered in the Appalachian and southeastern regions of the U.S. where smoking rates are highest. Over 60% of people living in rural areas who are eligible for lung cancer screening have to travel over 20 miles to a screening facility.

Lung cancer screening may also be costly. While most private insurances and Medicare cover the cost of lung cancer screening, Medicaid policies vary state by state and may not cover the cost of lung cancer screening. In addition, while some plans may cover the initial low-dose CT scan, they might not cover follow-up testing, procedures and treatment. Supplementary costs such as transportation, time off from work, child care and other logistical issues can also add up to create additional socioeconomic barriers to screening.

Communities that are under- or uninsured are at the highest risk of developing lung cancer. They often lack access to primary care providers, let alone specialists who can facilitate screening.

Erasing smoking stigma

Because lung cancer is linked to smoking, stigma plays a significant role in preventing many people eligible for screening from pursuing it. Many people eligible for lung cancer screening fear being blamed for their previous or current tobacco use.

Stigma also discourages patients from discussing lung cancer screening with their health care providers or community. Clinicians can partner with patients and communities to destigmatize lung cancer and tobacco dependence, extricating the disease from blame. Framing screening as a proactive measure to help those at risk of developing lung cancer and as a collaboration with those who need help quitting smoking can empower people to actively engage in screening rather than dreading or avoiding it.

Fear is another barrier. Many people believe that a lung cancer diagnosis is a death sentence. When diagnosed early, however, doctors treat lung cancer with an intention to cure. Additionally, advances in lung cancer treatment over the past 10-15 years have led to remarkable improvements in survival for all stages of the disease. Reassurance and education around next steps and paths to treatment at the time of screening help diffuse some of the distress surrounding lung cancer.

Public health researchers are exploring how to minimize the significant and complex barriers to lung cancer screening for those who need it most.

Nina Thomas, Assistant Professor of Pulmonary Sciences and Critical Care, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Baby boomers – that’s anyone born in the U.S. between 1946 and 1964 – are 20% of the population, more than 70 million Americans. Decades ago, many in that generation experimented with drugs that were both recreational and illegal. Although boomers may not be using those same drugs today, many are taking medications, often several of them. And even if those drugs are legal, there are still risks of interactions and side effects.

The taking of multiple medications is called polypharmacy, typically four or more at the same time. That includes prescriptions from doctors, over-the-counter medicines, supplements and herbs. Sometimes, polypharmacy can be dangerous.

I am a geriatrician, one of only 7,500 in the U.S. That’s not nearly enough to accommodate the surging number of elderly boomers who will need medical care over the next two to three decades – or help in dealing with the potential problems of multiple drug use.

Reactions to medications can change over time

We geriatricians know that polypharmacy isn’t always bad; multiple medications may be necessary. If you’ve had a heart attack, you might be on four medications or more – beta-blockers, ACE inhibitors, statins and aspirin, for instance. And that’s appropriate.

But about half of older adults take at least one medication that’s not necessary or no longer needed. Doctors need to periodically reevaluate to make sure each medication is still right for the patient and still the correct dose. During treatment, the patient’s weight may fluctuate, either up or down. Even if it stays the same, body composition might change; that occurs as people age. As a result, one may react differently to a drug. That can happen even with a medication a person has been on for years.

Polypharmacy often means higher health care costs and more drug interactions. Patients are more likely to miss medications or stop taking them altogether. Sometimes, physical activity diminshes; falls, cognitive impairment, malnourishment and urinary incontinence increase; there may be less ability to do daily tasks. Those on five or more medications have a much higher incidence of having an ADE – an adverse drug event – compared to those using fewer meds. Making matters worse, the symptoms of polypharmacy are sometimes masked and taken as signs of aging.

Check the list

Studies have suggested solutions, with better coordination among care providers being one. Making the pharmacist an integral part of routine care is another. The increasing use of electronic patient records helps. So do smartphone apps, sometimes an easier way for patients and providers to connect. But so far, there’s no magic pill, and as researchers and clinicians investigate improvements, much of the burden remains on patients and their families.

There are steps you can take to stay safe, however. Regularly clean out the medicine cabinet and get rid of expired medicines or those you’re no longer taking. Either throw them away or ask your doctor or pharmacist about the best way to dispose of them. When seeing the doctor, bring in the meds you take and review each one in detail. Make certain you need to continue taking them all and verify the right dose.

You can also check the PIMs list, also known as the Beer’s List. Published by the American Geriatric Society, it’s an index of medications potentially harmful to the elderly. Some are linked to increased risks of side effects, and not a few are sold over-the-counter without prescription.

That includes medicines containing antihistamines like diphenhydramine, or Benadryl. In the elderly population, Benadryl carries an increased risk of dizziness, confusion and urinary retention. Medicines that are part of the NSAID family (nonsteroidal anti-inflammatory drugs) are also on the list. In some elderly patients, they can cause high blood pressure or kidney failure. Commonly used medicines in the NSAID family are those containing ibuprofen or naproxen.

Just because a medicine is on the Beer’s List doesn’t mean your doctor was wrong to prescribe it, or that you should stop using it. Instead, use the medication with caution and discuss with your doctor to make sure you need it. Determine with your doctor the lowest useful dose, monitor for side effects, and speak up if you have any.

As a geriatrician, I see patients in an outpatient setting, either as their primary care provider or as a specialist consultant. We review medications at every visit: the list, the dose and how often the patient is taking it. A true and accurate medication list is the critical first step in geriatric care.

This is especially important during care transitions, such as when a patient is coming out of the hospital or nursing home. Particularly at that time, we find out if the patient is using the medication as prescribed, or taking it more frequently or less or not at all. Which leads to my final piece of advice: If you’ve strayed with your meds, one way or another, know that we doctors don’t judge or punish patients. Just tell us the truth. That’s all we want to hear. Then we can move forward together to find the best regimen for you.

Laurie Archbald-Pannone, Associate Professor of Medicine and Geriatrics, University of Virginia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Every vehicle built after 1981 has a unique vehicle identification number, or VIN. The location of this string of letters and numbers varies, but it’s located somewhere on every car, SUV, motorcycle and truck – typically on a small metal plate or a sticker.

VINs serve many purposes. They help consumers learn about a used car’s history, including whether it was stolen, or determine whether rebates for a particular electric vehicle are available. This code appears in the paperwork necessary to do everything from insuring your car to selling it.

I research data standards and became interested in VINs while doing research for my book about the cultural history of barcodes.

Like barcode numbers, a VIN’s characters are standardized. They can tell a story if you know what to look for.

What VINs can tell you

VINs can convey at least seven pieces of information.

1. Origin If a VIN begins with a 1, 4 or 5, that means it’s a vehicle assembled in the U.S. Many other countries have their own unique identifier. A 2, for example, means the vehicle was made in Canada; a J stands for Japan.

2. Manufacturer The second and third characters indicate the manufacturer. In some cases, the code corresponds with a line of vehicles that now belongs to a larger corporation. Dodge and Jeep, now part of Stellantis, each has its own. So does Lincoln, which became a division of Ford Motor Co. in 1922.

3. Description The fourth through eighth characters provide several details, such as body type and engine type.

4. Security The ninth character is a “check digit” determined by a complex mathematical equation based on the rest of the VIN’s numbers and letters. This digit, either a number or the letter X, is used to authenticate that the VIN is not a forgery.

5. Year The 10th character indicates the model year. There’s only one slot for this, and not all letters and numbers are used, resulting in repetition. An R could signal either 2024 or 1994, for example.

6. Factory The 11th character indicates the specific plant where the vehicle was assembled.

7. Serial number The VIN’s final six characters compose a serial number that differentiates the vehicle from all others made in the same factory that are the identical type and model year.

Finding more information

Only experts can tell where a vehicle was assembled or what type of engine it has by looking at its VIN. But help is available.

The National Highway Traffic Safety Administration provides a handy VIN decoder. When I plugged my vehicle’s VIN into the decoder, the site correctly determined that my SUV is a 2011 Subaru Forester with an automatic transmission.

Of course, I already knew all that.

What I didn’t realize was that it weighs between 4,000 and 5,000 pounds, has a 2.5-liter engine and features side curtain airbags to protect the driver and passengers in the front and back seats. I also learned that this Subaru Forester was assembled in Gunma, Japan.

Those details had been invisible to me as a consumer, but they had been within easy reach ever since I bought my Forester in 2018. I had somehow driven that car well over 100,000 miles without realizing the number on the side of my driver’s seat contained some history.

Before buying the Forester, even though I didn’t know that my VIN could say so much, I did run it through a free online system to make sure it hadn’t been stolen.

To be sure, VINs won’t tell you everything you might want to know about a vehicle, such as what color it was when it rolled off the line. But if you can do a little decoding and make use of widely available online tools, they do harbor important information.

Jordan Frith, Pearce Professor of Professional Communication, Clemson University

This article is republished from The Conversation under a Creative Commons license. Read the original article.