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What to Know About Lung Cancer Screening

Lung cancer screening

Lung cancer, the leading cause of cancer death among both men and women, is more likely to be cured when detected early. The five-year survival rate is about 60% when the disease is confined to one lung.

However, the majority of cases are diagnosed after the cancer has already spread to both lungs or other organs, at which point  the five-year survival rate is 20% or less. Delayed diagnoses are due in part to the fact that lung cancer symptoms often do not appear until the disease has progressed to more advanced stages.

This is why lung cancer screening, a test that detects the cancer before any symptoms have appeared, is critical for anyone with a high risk of lung cancer. Some studies have found that screening detects 80% of lung cancer cases at an early stage. Read on to learn more about what to expect during lung cancer screening and whether it may be right for you.

Lung cancer symptoms and risk factors

Smoking is the number one cause of lung cancer, contributing to 80-90% of lung cancer fatalities. However, there are additional risk factors to developing lung cancer:

  • Secondhand smoke
  • Exposure to radon, a naturally occurring gas that can get trapped in houses and buildings, and the second leading cause of lung cancer
  • Exposure to asbestos or other carcinogens like uranium, diesel exhaust, and inhaled chemicals in the workplace
  • Radiation therapy to the chest during cancer treatment

While lung cancer symptoms typically appear once the disease has progressed to a more advanced stage, some people do experience some of the following early signs of lung cancer:

  • A cough that does not go away or gets worse
  • Coughing up blood
  • Chest pain that often worsens with deep breathing, coughing, or laughing
  • Hoarseness
  • Loss of appetite
  • Unexplained weight loss
  • Shortness of breath
  • Feeling tired or weak
  • Infections such as bronchitis and pneumonia that don’t go away or keep coming back
  • New onset of wheezing

Many of these symptoms overlap with those of other respiratory conditions like COPD, and you should schedule an appointment with your doctor as soon as possible. Even if you do not have lung cancer, it’s important to identify the cause of these symptoms and treat them, if needed.

What happens during lung cancer screening?

During your lung cancer screening, doctors will use a non-invasive test known as a low-dose computerized tomography (LDCT) scan to search for abnormal spots in the lungs that could be cancer.

During the scan, you will lie still on a long table as it slides through a machine that uses a low level of radiation — about half of what you’re exposed to naturally from the environment every year, and much less than what you’d be exposed to in a standard CT scan — to create images of your lungs. It is painless and will take less than a minute.

If you are experiencing signs of a respiratory infection such as congestion, runny nose, sore throat, and body aches, or if you recently recovered from one, let your doctor know as it may affect the results of an LDCT scan. They will let you know if you should reschedule.

There are several possible outcomes of an LDCT scan. If the screening test detects abnormal spots, often called a nodule, you may need additional tests to determine if you have lung cancer.

For small nodules, doctors often recommend another LDCT scan after a few months to see if the nodule has grown. If the nodule is bigger, your doctor may order additional testing like a positron emission tomography (PET) scan or a biopsy, a procedure that removes a piece of the nodule for lab testing, to find out if it is cancerous.

In cases where lung cancer screening does not detect any abnormal spots, your doctor may recommend continuing with annual screening depending on your risk.

Who is lung cancer screening for?

Since lung cancer screening involves exposure to radiation, doctors primarily reserve screening for people at high risk of developing lung cancer, namely older adults who have smoked heavily for many years.

The U.S. Preventive Services Task Force (USPSTF) — an independent group of prevention experts who help healthcare providers make informed recommendations for their patients — recommends annual LDCT lung cancer screening for people who meet each of the following criteria:

  • Have a 20 pack year or more smoking history
  • Smoke now or have quit within the past 15 years
  • Are between 50 and 80 years old

A “pack year” is defined as smoking an average of one pack of cigarettes per day for a year.  The 20 pack year history threshold could be met by smoking one pack a day for 20 years or two packs a day for 10 years. It’s important to share all the details of your smoking history with your doctor so they can determine if you would benefit from lung cancer screening.

Your doctor may also recommend lung cancer screening if you were treated for lung cancer more than five years ago, have another serious lung disease such as chronic obstructive pulmonary disease (COPD), a family history of lung cancer, or have been exposed to asbestos at work.

They will also take your overall health into account, as lung cancer screening is typically recommended for individuals who would be physically able to tolerate treatment for early-stage lung cancer and lung surgery, if it is needed.

Risks of lung cancer screening

While lung cancer screening saves lives — without screening, 70% of lung cancer cases would be detected at a later stage — it carries some risks, like all screening procedures.

First, while the level of radiation you are exposed to during an LDCT scan is not significant, it can potentially become harmful with repeated scans. In addition, when screening for any disease, doctors will sometimes find abnormalities that look cancerous but are not, which is referred to as a false positive. They may also find cancers that grow so slowly they would never lead to symptoms.

The frequency of false positives continues to decline every year. Currently, about 12-14% of lung cancer screenings have a false positive, similar to the rates for mammograms. False positives are even less common with continued annual LDCT screening since it is easier to identify notable changes between the scans. 

Plus, as the technology behind lung cancer screening evolves, doctors have a clearer understanding of who actually needs follow-up testing after the initial LDCT scan. Ultimately, it is important to discuss the benefits and risks of lung cancer screening with your doctor and work together to determine if you would benefit from it.

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This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.