Lung Cancer Screening

Know Your Risk of Lung Cancer, Even If You’ve Quit Smoking
By Christian Gálvez, MD 

It can literally be a matter of life and death. If you are a current or former smoker, your risk of developing lung cancer could be 25 times higher than someone who never smoked.  Today, there’s only one proven way to dramatically improve the likelihood of surviving lung cancer if you get it – early detection through low-dose computer tomography (CT) screening, which leads to treatment of early stage lung cancer.

In 2016, the American Cancer Society predicts there will be 224,000 new cases of lung cancer in the U.S., and of those patients, 158,000 will die from the disease. Lung cancer remains the leading cause of cancer deaths. Eighty-seven percent of those cancers are caused by smoking. If lung cancer is detected early, patients can have up to an 88 percent survival rate 10 years following diagnosis.

Unfortunately, more than 85 percent of lung cancer cases are detected too late for effective treatment. That’s why primary care physicians urge their at-risk patients – particularly those with significant smoking histories – to get screened. The best solution of all, of course, is to quit smoking. But even if you’ve done that, screening is still strongly recommended for high-risk patients.

WHAT is lung cancer screening?
Lung cancer screening is done with a low-dose CT scan that can identify small nodules (spots on the lungs) or other abnormalities, ideally at an early stage, before there are any outward symptoms. Most of these nodules will not be cancer and that will be determined by additional imaging studies or biopsy.
WHY is this type of screening done for lung cancer?
It’s the only way to detect lung cancer in its earliest stages. Lung cancer often is not detected until it is advanced and a cure is not possible. Clinical trials consistently have shown that screening high-risk patients before symptoms appear can detect lung cancer early, when it is easier to treat and more likely to be cured. The likelihood of surviving cancer is greatly improved – by as much as 20 percent. Said another way, if the entire at-risk population of the US. were to be screened for lung cancer, we would prevent 12,000 deaths a year.

Who should get screened?
The National Comprehensive Cancer Network recommends that patients without symptoms of lung cancer be assessed for risk based on these factors: age, smoking history, radon exposure, occupational exposure, personal cancer history, family history of lung cancer, lung disease history, and secondhand smoke exposure. Screening with Low dose CT is recommended for these patients at high risk:

Category 1: Patients 55 to 74 years old with a 30 or more “pack-year history” (calculated as the number of packs per day times the number of years smoked). If patients have quit, they must have stopped within the past 15 years

Category 2: Patients age 50 or older with a 20 or more pack-year history of smoking and one additional risk factor other than second-hand smoke (family history of lung cancer in first-degree relatives, occupational exposure to lung carcinogens, personal history of chronic obstructive pulmonary disease or pulmonary fibrosis, radon exposure, personal history of smoking-related cancer, prior radiation to chest or neck).

How about the risks?
You will be exposed to low levels of radiation during the test – more than an x-ray but much lower than a regular CT scan you might have if you already had cancer symptoms. It’s about the same level of radiation from six months in your natural environment. Screening is not perfect. Some cancers can be missed (false negative) and some may look like a cancer when they are not (false positive).

Where are these screenings done?
It is an outpatient procedure at hospitals and certified clinics throughout the U.S., generally through referrals by primary care physicians. 

When should I think about getting screened?
Now. If you think you meet the risk profile, talk to your doctor about scheduling a screening. It could save your life. 

Christian Galvez, MD, is a thoracic and general surgeon at Berkshire Medical Center