Q&A: Mary Salvatore, MD, on Who Should Get Screened for Lung Cancer

November 28, 2023

Cigarette smoking, the number one risk factor for lung cancer, is linked to roughly 80% to 90% of all lung cancer deaths in the United States. It is the third most common cancer in the United States, behind skin and breast cancers, but more Americans die of lung cancer than any other type.

Recently, the
American Cancer Society (ACS)updated its lung cancer screening guidelines to help reduce the number of people dying from the disease due to smoking history. The new guidelinesrecommend yearly screening involving a low-dose computed tomography (CT) scan for people aged 50 to 80 years old who smoke or formerly smoked and have a 20-year or greater pack-year history.

Mary Salvatore, MD

Mary Salvatore, MD

Mary Salvatore, MD, a professor of radiology at Columbia University Irving Medical Center (CUIMC)and member of the Herbert Irving Comprehensive Cancer Center (HICCC),specializes in lung cancer screening and works within the Lung Cancer Screening Program at CUIMC. Below, Dr. Salvatore discusses her thoughts on the new guidelines, the Lung Cancer Screening Program, and how being a former smoker impacts her work.

Why were the lung cancer screening guidelines expanded? What are your thoughts on the change?

National Lung Cancer Screening Trial studied smokers or former smokers aged 55 to 74 years old with a 30 pack-year history who hadn’t stopped smoking more than 15 years ago. But then research came out saying that only about 25% of the people who were in that age range and fulfilled those criteria were the ones who actually developed cancer. So, the old guidelines were missing 75% of the cancers.

So the ACS expanded the numbers more recently to be 50 to 80 years old with a 20 pack-year history of smoking. That covered a broader range of patients, but there are still so many people I can think of who are not within that category. Maybe most vulnerable are patients exposed to secondhand smoke, like the flight attendants who weren’t smoking themselves. That’s an area that should be considered and included in the guidelines.

My work is in pulmonary fibrosis, which has a higher risk factor for developing lung cancer than emphysema. Yet, it is not included as a reason for screening for lung cancer. I would advocate that all people who have fibrosis be screened on a yearly basis.

You helped launch the Lung Cancer Screening Program at Columbia and NewYork-Presbyterian launched over a year ago. How is it going?

The program was challenging to start, but now it’s just blossoming. Almost as soon as we had the pieces in place, it has effortlessly grown in leaps and bounds, from 8 referrals a month to now 70 referrals a month of new patients getting their CT scans. The receptiveness of the referring clinicians, the patients, and the community has been wonderful.

It’s surprising to me how well it’s going — not in a bad way, but getting people screened usually is an uphill battle. Of all the people who are at risk for developing lung cancer, so few of them get screened.

Many smokers feel that once they’ve started, there’s no point in quitting because it won’t reduce their lung cancer risk. Is that true?

It’s best to stop smoking whenever you are able to, because your risk of lung cancer immediately starts to go down. As a former smoker, your risk is lower than that of a current smoker, but remains higher than a nonsmoker.

If you’re trying to get a loved one to quit, having them get a CT scan for lung cancer is a good first step. If it’s normal, they’re like, “Thank godness, let me stop smoking now so I don’t do more damage.” If it’s abnormal, they’re terrified and want to stop immediately. So, either way, it’s a very powerful motivator.

How does being a former smoker inform your work with screening patients for lung cancer?

In the 80s, everybody was smoking. We smoked in the hospitals. When we would go see patients, we would smoke with the patients. It was a different world. For me, personally, when I had my children, it became very easy to stop. I was surprised at how easy it was to quit compared to what I had heard. 

When I meet with patients, I share with them that I had been a smoker, and I was able to stop. So many of my patients stopped smoking just by me talking with them about their result and saying it wasn’t that hard to quit. It can be helpful for patients to talk to someone who successfully stopped smoking. I think most smokers feel embarrassed, so it’s very liberating when you can kick the habit. It makes you feel very successful. It is a great feeling to be able to stop smoking.

Columbia Medicine on Instagram: "As a former smoker, #ColumbiaMed radiologist Dr. Mary Salvatore understands the challenges and #stigma people who are trying to quit 🚭 may feel.