Whether you still smoke or quit, lung screening is strongly recommended
By Christian Gálvez-Padilla, MD  

Though cigarette smoking has reached the lowest level ever recorded among U.S. adults, it still remains the number-one cause of preventable disease and death, accounting for more than 480,000 deaths every year, or about 1 in 5 deaths. Lung cancer alone is responsible for 29 percent of cancer deaths, more than those from breast cancer, colon cancer, and prostate cancer combined. 

Even so, nearly 40 million U.S. adults still smoke cigarettes. That’s 14 of every 100 Americans 18 years or older. And a new generation is being lured to the habit. Every day, about 2,000 U.S. youth younger than 18 years smoke their first cigarette.  According to the Centers for Disease Control and Prevention (CDC), some 4.7 million middle and high school students use at least one tobacco product, including electronic cigarettes.

Those numbers underscore not only the dangers of smoking and the persistence of the habit, but the need to carefully monitor the health of both current and former smokers.  Whether or not you’ve quit, your odds of developing lung cancer are 25 times higher than someone who never smoked.  Today, there’s only one proven way to dramatically improve your chances of surviving lung cancer if you get it – early detection through low-dose computer tomography (CT) screening.

If lung cancer is detected early, patients can have up to an 88 percent survival rate 10 years following diagnosis.  Sadly, more than 85 percent of lung cancer cases are diagnosed 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.  

A low-dose CT scan can identify small nodules (spots on the lungs) or other abnormalities 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. Radiation exposure from the initial screening is low – more than an x-ray, but about the same level as six months in your natural environment. 

Studies 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. 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).

Lung screening is an outpatient procedure at hospitals and certified clinics throughout the U.S. Most screenings are done through referrals by primary care physicians, but you can also schedule a screening without a referral. The screenings usually are covered as a preventive service at no cost by most private health insurance plans as well as by Medicare.

Christian Gálvez-Padilla, MD, is a thoracic and general surgeon at Berkshire Medical Center.