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Get an inside look at the patients team at Alto Pharmacy to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

Get to Know the Team That Builds Alto's Customer-Facing Apps

Imagine an app that allows you to buy things and have them delivered to you the same day, for free. Now take that app and put it in a highly regulated space like pharmacy. You face the challenge not only of building an e-commerce platform from scratch, but also of navigating medication pricing, federal and state regulations, and patient safety—and that's just the way the Patients Team likes it.

"It's a really exciting and fun problem to solve," says Mike Riess, the team's Engineering Manager. Software Engineer Angelique Nehmzow agrees: "There's a really strong product and design aspect, like more traditional startups, but then everything gets a little bit more interesting because it's healthcare."

Below, we chat with the team to learn what it's like to work on Alto's customer-facing apps, which projects are on the horizon, and who makes the best barbecue short ribs.

What does the Patients Team do at Alto? 

Ask anyone on the team why they joined, and chances are, they'll tell you they wanted to be on the product team closest to Alto's customers: "We really try to own the customer experience," says Peter Zeng, the latest Software Engineer to join the team. "If a customer is coming to the web app, or they're coming to our mobile app, we want to make sure that they're able to onboard with us as easily and conveniently as possible."

The team is also responsible for the customer experience beyond onboarding, from the moment a customer schedules a medication for delivery to the time that it shows up on their doorstep. "We already offer great services like free, same-day delivery and cost savings. The Patients Team empowers customers to make the most of our offering," Nehmzow explains. "You can see what prescriptions you have, check on the status of your order, and schedule automatic refills. In a more traditional pharmacy, you don't get that kind of visibility. You have to call them up or even wait in line in person. At Alto, it's a different experience."

What was it like in the team's early days?

Today, there are eleven engineers on the team working to build that better end-to-end experience—but it wasn't always that way. When the team first formed in 2019, it consisted of just three members: Riess, Brian McRae, and Andy Lau, all of whom are still on the team.

"The first priority for us was just stabilizing the foundations," Riess says of the team's early days. Every other week, the three team members, along with Alto co-founders Matt Gamache-Asselin and Jamie Karraker, would meet to audit the app's core flows. "For the first three months we probably didn't make it through some flow at least 50% of the time," Riess recalls. "There would be a ton of bugs in the onboarding experience, things that weren't working with the flows or navigation or deep linking."

Among the team's first projects was a redesign of the checkout flow. "There was a lot of work to be done to streamline the checkout flow, which is pretty much the main function of the app," says McRae, who initially joined the team as a software engineer and later transitioned into product management. "We had to make it easier to add a payment, add your addresses, everything you need to do to schedule your prescription for delivery."

"The growth of the team, in terms of both size and stability of the platform, has allowed us to swing at more interesting bets for the company," Riess says. In particular, the Patients Team has turned their attention toward experiences personalized for specific medical conditions.

"Different customers have different needs. A customer who wishes to start a family will have a different experience than a customer who needs to order their routine heart medications that they've been taking for the last eight years,” McRae says. “The challenge for us is how we serve all these customers well through the app."

"I think that's where Alto can be such a differentiator," Riess adds. "A world-class pharmacy experience is about so much more than just dispensing medications. We want to build tools for customers that help them get the most out of their medications—everything from simple videos teaching them how to perform injections safely at home to the ability to synchronize deliveries for multiple prescriptions for managing complex health conditions."

With these new projects on the horizon, engineers have ample opportunity to focus on the areas that excite them most. "We're full-stack and mobile and web," Nehmzow says. "Part of the team focuses more on experimentation, iterating quickly, and using data to make decisions. Part of the team focuses more on platform work, tooling, and improving the developer experience. There are a lot of areas to explore and contribute to."

One spring night, the Patients Team gathered in a back yard in San Francisco’s Mission District for short ribs and an impressive spread of side dishes. "Kudos to Robbi, who's the grill master. I just provide the grill!" Nehmzow says, laughing. While the team barbecue was the first time some members had met in person, Zeng notes that the team has been supportive of one another even while working remotely during the pandemic.

"The first real project that I was assigned to was working with the communications system. Before writing my first piece of code, I spent two weeks exploring what already exists and understanding the different parts of the system," Zeng says. "I've been really impressed with how understanding my teammates have been. They make the space for you to learn all the different pieces of code we own."

That culture of support is by design, reflected in the six principles—complete with matching emojis—at the top of the #patients-team Slack channel: "Empower each other," "be an owner," "find the path," "learn by doing," "embrace complexity," and "foster trust." 

While these principles echo Alto's company-wide values, they are unique to the Patients Team. "For a long time, we were the only external-facing product team at Alto," Riess says. "These principles were intended to be this motivation around how we win. It's a combination of how we treat each other, how we reason about decision making, and how we approach solving a problem that's never existed before."

As the team looks toward the future, those principles have never been more relevant: "We have a goal and an area we want to focus on, but in terms of which projects we're going to do, it's not a top-down thing," Nehmzow says. "It's very much, 'We're going to figure out how to solve this problem together, even when it's difficult.' That's my favorite part about the team."

The Patients Team is hiring! Learn more about open positions here.

While gestational diabetes can be an upsetting diagnosis to receive, it is very manageable.  With an effective treatment plan you can manage your blood sugar levels and have a healthy pregnancy.

Gestational Diabetes: Signs, Causes, and Treatment

Gestational diabetes is a type of diabetes diagnosed during pregnancy. It affects approximately 10% of pregnancies, and millions of women, in the U.S. every year. Like all types of diabetes, the condition involves complications with the body’s production of insulin, a hormone that converts sugar into energy. If untreated, it can lead to high levels of blood glucose, which can lead to complications for both you and your baby.

While gestational diabetes can be an upsetting diagnosis to receive, it is very manageable.  With an effective treatment plan, including a healthy diet, exercise, and, if needed, medication, you can manage your blood sugar levels and have a healthy pregnancy.  

During your pregnancy, hormone level changes can affect how your body processes sugar. The placenta — an organ in your uterus that forms by week 12 of the pregnancy to deliver nutrients to your baby — produces a variety of hormones. Gestational diabetes occurs when some of these hormones, specifically estrogen, cortisol, and human placental lactogen, interfere with insulin function, causing blood sugar levels to rise.

Gestational diabetes typically develops in the middle of pregnancy, and most doctors test for it between weeks 24 and 28. There often aren’t any noticeable symptoms, and some of the key signs of gestational diabetes overlap with other changes that occur during pregnancy like being thirstier or hungrier and urinating more frequently than usual.

Most women who develop gestational diabetes are over 25. In addition, you are more likely to develop gestational diabetes if you:

Were overweight before you became pregnant

Are Black, Hispanic/Latino, Native American, Asian American, or Pacific Islander

Have prediabetes, a condition in which blood sugar levels are elevated but still below the official threshold for a diabetes diagnosis

Have had gestational diabetes during a previous pregnancy or gave birth to a baby over nine pounds

Have polycystic ovary syndrome (PCOS) or another health condition linked to problems with insulin

Have high blood pressure, high cholesterol, heart disease, or other medical complications

If any of these risk factors apply to you, you should consult with your doctor early on in your pregnancy to assess your risk and determine which preventative measures to take, if needed.

Your doctor will screen for gestational diabetes between weeks 24 and 28 of your pregnancy with a glucose tolerance test (or earlier if you have one or more of the key risk factors). During this test, you will drink a sweet beverage that contains 50 grams of glucose to raise your blood sugar. An hour later, your blood glucose levels will be checked to see how your body responded to the sugar in the drink.

If your blood sugar is higher than a certain threshold after the one-hour glucose tolerance test, your doctor will order additional testing. The most common follow-up is a three-hour glucose tolerance test. For this test, you will fast for eight hours and have your fasting blood sugar measured. You will then drink a beverage that contains 100 grams of sugar. Afterwards, your blood glucose will be tested one, two, and three hours later.

Your doctor may screen you again for gestational diabetes if your results are normal but you are at high risk.

Potential complications of gestational diabetes

Without prompt treatment, high blood sugar levels in a pregnant woman can affect the health of both her and her baby. For instance, unmanaged gestational diabetes can increase the baby’s blood sugar levels, which in turn increases its weight. A woman carrying an overweight baby may have to deliver it via a C-Section, which involves a longer recovery from childbirth.

Another complication that can potentially affect a pregnant woman as a result of gestational diabetes is preeclampsia, a condition characterized by high blood pressure and damage to the liver, kidneys, or other organs.

Despite these potential health risks, gestational diabetes is highly manageable. Your doctor can advise you on appropriate steps to keep your blood sugar levels in a normal range so that you can experience a healthy pregnancy. However, it’s critical to take action as soon as possible if you receive a diagnosis.

Eating healthy foods and exercising regularly play a big role in managing your blood sugar levels and controlling your gestational diabetes. Your doctor will advise you on specific dietary considerations.

In general, swapping sugary snacks for sources of natural sugar such as fruits and carrots and adding vegetables and whole grains to your diet can help keep you and your baby healthy. Portion control is also important, and it is often recommended to eat three small meals throughout the day along with several snacks.

Staying active is also key. Try to aim for about thirty minutes of moderate activity several days throughout the week. Opt for gentle workouts like swimming, or try a yoga class specifically tailored to pregnant women. Not only will this help manage your blood sugar levels, but it has the added bonus of helping you avoid fatigue and backaches during pregnancy.

Your doctor may advise you to check your blood sugar levels several times throughout the day using a blood glucose meter. The American Diabetes Association suggests the following blood sugar targets for pregnant women:

Two hours after a meal: 120 mg/dl or less

Depending on your specific blood sugar levels, your doctor may advise you to take insulin. If taking insulin, it’s important to pay regular attention to your blood sugar as insulin therapy can lead to hypoglycemia, or dangerously low blood sugar. Hypoglycemia often happens as a result of not eating enough or exercising too much.

Common hypoglycemia symptoms include shakiness, anxiety, feeling lightheaded, hunger, nausea, headaches, and seizures. The only way to confirm that you are experiencing hypoglycemia is to check your blood sugar with a blood glucose meter or a continuous glucose monitor (CGM). 

Your doctor can help you develop your blood sugar targets and identify specific numbers to watch for when checking for hypoglycemia. However, if you are experiencing signs of low blood sugar and unable to check blood sugar levels, treat symptoms with high-sugar foods or drinks.

Getting tested for diabetes after pregnancy

For most women with the condition, gestational diabetes typically goes away soon after delivery. However, 5-10% of women with gestational diabetes develop type 2 diabetes after giving birth. And about 50% of the new mothers whose blood sugar levels return to normal after delivery will develop type 2 diabetes later in life.

If you have had gestational diabetes, it’s important to regularly monitor your blood sugar and continue with exercise and a healthy diet after giving birth to avoid health complications. You should also get screened again for diabetes 6 to 12 weeks after giving birth, and then every 1 to 3 years.

We’re here to support your gestational diabetes treatment

Alto is here to help you manage your gestational diabetes, by consolidating medications into streamlined monthly deliveries, setting up automatic refills, and offering free same-day delivery. And if insulin therapy is a part of your treatment plan, our pharmacists are available to walk you through your first doses and discuss any symptoms or side effects.

Learn how we can support your gestational diabetes treatment plan by contacting us via phone at 1-800-874-5881 or in-app messaging.

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.

For many transgender men and women, hormone replacement therapy is an important component of their transitioning process. Here is an overview of hormone replacement therapy medications and side effects.

What to Know About Transgender Hormone Therapy Side Effects

For many transgender men and women, hormone replacement therapy is an important component of their transitioning process, allowing them to develop physical traits aligned with their gender identity. Taking this step to feel more comfortable in your body is a big decision, and there are many factors to consider as you determine if gender-affirming hormone replacement therapy is right for you. 

Below is an overview of hormone replacement therapy medications and side effects to help you learn more about the process.

Hormone replacement therapy for transgender women

Estrogen and testosterone-blocking medications help transgender women develop a more feminized appearance in line with their gender identity while transitioning. It reduces the discomfort of gender dysphoria, the distress caused by having a gender identity that differs from the sex you were assigned at birth. Many transgender women experience less emotional distress, improved personal relationships, and a better overall quality of life as a result of hormone replacement therapy.

Feminizing hormone replacement therapy causes a variety of physical changes like breast development and facial and body hair reduction. You may also experience a loss of muscle tone and changes in your body shape as the body redistributes fat cells.

Feminizing hormone replacement therapy medication and timing

While your healthcare provider will help you develop an individualized treatment plan, feminizing hormone therapy often begins by taking 100 to 200 milligrams daily of a diuretic called spironolactone to begin blocking male hormone receptors and suppress testosterone production. Some individuals begin taking estrogen immediately, in tandem with spironolactone, to further reduce testosterone production and develop more feminine characteristics. In other cases, estrogen is introduced after several weeks of spironolactone use. Your doctor will recommend the best plan for your needs.

There are various methods for administering estrogen, including orally, by injection, or as a cream, gel, spray, or patch. Commonly used forms of estrogen during a male-to-female transition include:

Oral: Estradiol tablets. 
Note that your doctor may advise you to let the tablets dissolve under your tongue rather than swallowing them. This is called sublingual administration, which may lower your risk for blood clots since it bypasses the liver.

Injections: Estradiol valerate (branded options include Delestrogen®) and estradiol cypionate (branded options include DEPO®-Estradiol)

Feminizing hormone replacement therapy side effects

You may experience one or more of the following hormone replacement therapy side effects. Your doctor can advise you about the potential risks and benefits prior to starting hormones.

A blood clot in a deep vein (also known as deep vein thrombosis) or in your lungs

High levels of triglycerides, a type of fat found in the blood

Feminizing hormone replacement therapy may also increase your risk for some chronic health conditions. Since estrogen affects how your body responds to insulin, it can lead to changes in your blood sugar levels and a greater risk for type 2 diabetes. Research into the impact of estrogen on your cardiovascular system is ongoing, and some studies have found a connection between estrogen therapy and a greater risk for heart disease and stroke. You may also face a greater risk of breast cancer after starting hormone replacement therapy.

Certain underlying health conditions may increase your risk of health complications related to the use of estrogen and testosterone-blocking hormones. It’s important to share your full medical history with your doctor, especially if you’ve had a hormone-related cancer, like prostate cancer, or a history of blood clots.

Gender-affirming hormone replacement therapy may affect your fertility, as it impacts sperm production. While some transgender women can produce sperm again after stopping hormone treatment, research indicates that this may not be the case universally, and there is a risk of permanent infertility with long-term use of hormones. If you would like to have biological children, ask your doctor about your options with freezing your sperm before starting hormones.

Hormone replacement therapy for transgender men

Hormone replacement therapy for transgender men during a female-to-male transition also combats gender dysphoria, leading to reduced emotional discomfort and better overall mental health.

During the process, you will take testosterone, which decreases estrogen production and suppresses menstruation. Testosterone is typically administered by injection (branded options include Delatestryl® and Tesamone®) or as a gel applied to the skin (branded options include AndroGel®, Testim®, Fortesta®, and Axiron®). In some cases, it may be applied as a patch or pellets positioned under the skin. If you have a persistent menstrual flow, your doctor might recommend taking progesterone to control it.

You may observe some of the following physical changes within several months of starting hormones, though individual responses to treatment varies:

Masculinizing hormone replacement therapy side effects

There are several potential side effects that transgender men may experience as a result of hormone replacement therapy, including the following:

Masculinizing hormone replacement therapy may also increase your risk for type 2 diabetes and cardiovascular disease.

You are more likely to experience one or more of these health complications if you have had breast cancer or have a history of blood clots. It may be unsafe to continue with hormone treatment if you are pregnant or breastfeeding. Be sure to discuss the potential risks and benefits of hormone replacement therapy with your doctor, and make sure they are aware of your full medical history.

Masculinizing hormone therapy and fertility

While some transgender men have sucessfully undergone egg freezing or IVF after starting hormone therapy, long-term use of hormones may lead to permanent infertility. If you want to leave open the possibility of starting a family by having children biologically, consult your doctor about your options for egg freezing before starting treatment.

Given that individual responses to testosterone treatment vary, you have a chance of becoming pregnant even while taking hormones. Your doctor can advise you about your options for birth control.

Baseline and follow-up testing for hormone replacement therapy

Before you begin hormone replacement therapy, your doctor will order tests to measure your baseline lipid, blood sugar, liver enzyme, and electrolyte levels, which may change throughout the course of your treatment. Your doctor will also evaluate your medical history to identify any health conditions that may affect treatment. This is also a good opportunity to discuss reproductive health and fertility considerations, including potential contraception options if you are a transgender man.

Throughout hormone therapy, you will have regular follow-up appointments with your healthcare provider to document physical changes in your appearance and monitor the impact of hormones on your lipids, blood sugar, and liver enzymes.

Hormone replacement therapy affects you emotionally as well as physically. In the long term, gender-affirming treatment, including both hormone therapy and surgery, can lead to better mental health, reducing the need for depression and anxiety-related treatment. 

Your doctor will likely ask questions related to your mental health during your initial consultation — including any symptoms of gender dysphoria that you have experienced and how they impact you at work, school, or home — and continue the conversation throughout your treatment.

It’s important to be honest with your doctor about how you are feeling — your mental health matters as much as your physical health. Don’t be afraid to ask for mental health-related resources if you need extra support, and remember that your doctor is here to help you without judgment.

View the National Institute of Mental Health’s suggestions for finding mental health treatment, and the Human Rights Campaign’s list of LGBTQ mental health resources.

Alto is here to support your journey with hormone replacement therapy. Our team of patient care pharmacists has experience working with the LGBTQ+ community and is available to answer any questions you have about the process.

We also make it as simple as possible to stay on top of your medications, with same-day delivery and mediation management tools like reminders and auto refills in our app. Reach out any time to get started by phone at 1-800-874-5881 or download the app for secure messaging with our care team. 

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Learn more about the fertility considerations specific to TGNB individuals.

Fertility Options for Transgender, Gender-Queer, and Nonbinary (TGNB) Individuals

The face of fertility treatment continues to evolve, with more and more LGBTQ+ couples and individuals seeking to become parents. Transgender, gender-queer, and nonbinary (TGNB) individuals have multiple options for starting a family, including fertility preservation treatment and using a donor or surrogate for several or more of the components of biological conception. Below, we explain more about the fertility considerations specific to TGNB individuals and potential paths to explore as you plan to start a family.

Each person’s journey to parenthood looks different. Transgender, gender-queer, and nonbinary individuals have specific factors to consider in planning for a family, as the biological process of transitioning may affect your ability to conceive.

Many transgender and nonbinary individuals take hormones like testosterone, estrogen, and testosterone blockers, or anti-androgens, while transitioning. Testosterone suppresses feminine physical traits and induces masculine ones in transgender men and some nonbinary individuals, such as facial and body hair and a deeper voice. Estrogen increases feminine characteristics like breast development and facial and body hair reduction in transgender women and some nonbinary individuals.

Researchers are still learning about the impact of testosterone and estrogen therapy on long-term reproductive function. While prolonged testosterone and estrogen use often stop sperm production and ovulation, respectively, some evidence, like a 2019 study on transgender fertility from Boston IVF, suggests that these effects are reversible upon discontinuation of the treatment.

Based on eight years of patient data, the Boston IVF study found that transgender men who underwent egg freezing for fertility preservation had similar egg yields as cisgender women, or women whose sex assigned at birth was female. More than half of the study’s transgender male participants had taken testosterone before pursuing ovarian stimulation treatment, all of whom had discontinued use of the hormone for an average of four months prior to starting their egg freezing cycle.

While the study’s results affirm that hormone therapy may not necessarily prevent you from having children biologically, every person’s situation is different. If you are considering hormone therapy and want to have children in the future, consult with your doctor about the possibility of freezing your eggs or sperm for future use, a process we explain in more detail below.

In addition, there is currently no definitive evidence that testosterone therapy will prevent individuals assigned female sex at birth from becoming pregnant. Depending on your ideal timeline for starting a family, you may also want to discuss contraception options with your healthcare provider.

For many transgender and nonbinary individuals, gender confirmation surgery is an important aspect of transitioning. It plays a crucial role in addressing gender dysphoria, the distress caused by the disconnect between your gender identity and the sex you were assigned at birth.

Depending on the circumstances, gender confirmation surgery may permanently affect your reproductive function. For instance, hysterectomies are performed in some female-to-male transitions, which prevents the possibility of carrying a child in the future. The removal of testicles during a male-to-female transition may also impact your ability to have biological children.

By planning for the future and discussing your reproductive options with your healthcare provider before undergoing gender confirmation surgery, you may be able to preserve your fertility options.

Fertility preservation treatment for TGNB individuals

Many transgender and nonbinary individuals choose to preserve their eggs or sperm for future use before beginning the biological process of transitioning. Sperm freezing helps transgender women plan for a future family before starting estrogen therapy. 

This is a fairly simple process in which a sperm sample is either surgically retrieved or collected by the person freezing their sperm. Doctors will then analyze that initial sperm sample to determine if additional samples are needed. Your sperm will then be stored in vials with cryoprotectant agents that will help ensure its long-term viability.

In egg freezing, transgender men take fertility medications to stimulate egg production. Once the eggs are developed, your doctor will retrieve them from you in a minimally invasive procedure. Your eggs can then be frozen and stored for later use. Depending on how many eggs are yielded, you may have to undergo more than one cycle of egg freezing.

Read our previous blog to learn more about what to expect during egg freezing.

Fertility treatment and conception options

Transgender and nonbinary individuals and families have multiple options for having children biologically, including intrauterine insemination (IUI) and in vitro fertilization (IVF).

In IUI, transgender women can use their frozen sperm and have it placed into their partner’s or a surrogate’s uterus. If you elect to use a surrogate, they will also take on the role of egg donor, meaning that they will be the biological mother of your child.

In IVF, eggs and sperm are combined in a laboratory. The fertilized eggs, or embryos, are then placed into the uterus with the potential outcome of a pregnancy. As with IUI, transgender individuals have multiple options with IVF. 

Transgender men can use their own eggs or those of their partner or a donor to have the fertilized embryo implanted into their own uterus. The sperm may come from their partner or a donor. Alternatively, their partner or a gestational carrier may have the embryos implanted into their uterus. (A gestational carrier carries and delivers a child for an individual or couple and is not genetically related to that child whereas a surrogate offers both her eggs and uterus.)

Transgender women can have their sperm fertilized with eggs from their partner or a donor. Then, their partner or a gestational carrier may have the embryos implanted into their uterus.

IVF is a more complicated process than IUI from a medical standpoint, as it involves more fertility medications and an egg retrieval process. However, IUI can be more emotionally and legally complicated if you are using a surrogate. Take time to research all of your options so that you can determine the best one for your needs and know what to expect going in.

If you are exploring using a donor or surrogate, it’s critical to research your state’s laws about legal parentage procedures once your baby is born. In some states, a surrogate may automatically receive parental rights after your child’s birth since they are the biological mother, which will have to be legally terminated. Explore Movement Advancement Project’s interactive map on parental recognition laws as a starting point. You should also speak with an experienced LGBTQ+ family lawyer in your state before starting the process.Learn more about these paths to parenthood, including the related legal aspects.

Fertility treatment is a significant investment, both financially and emotionally. Determining how to pay for these expenses is an important part of planning your family. There are many resources such as EMD Serono’s financial assistance programs for fertility medications. Family Equality council also has a list of family-building grants that help LGBTQ+ families afford fertility treatment. Be sure to ask your fertility clinic about available financial assistance programs and payment plans.

At Alto, we’re committed to doing whatever we can to minimize stress during fertility treatment, including supporting your financial well-being. If fertility medications are a part of your path to parenthood, we will work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to make your medications as affordable as possible.

Read our previous post on managing the costs of fertility treatment.

A fertility pharmacy partner you can rely on

Alto is here to support your journey with starting a family. We know that there are many paths to parenthood and that each individual or family’s needs are different. Our team of patient care pharmacists has experience working with the TGNB community, and we’ll be here at every step of the way if you choose to pursue any of the fertility treatments described above. We also offer discrete, private packaging and free, same-day delivery to keep stress at minimum during this special time in your life.

Reach out any time through in-app secure messaging or by phone at 1-800-874-5881.

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. Here's what to know.

What to Know About 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.

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:

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

Chest pain that often worsens with deep breathing, coughing, or laughing

Infections such as bronchitis and pneumonia that don’t go away or keep coming back

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.

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

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.

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.

At Alto, we go above and beyond to help you stay on track with your doctor’s recommendations, getting you the medication you need at the best price possible. And our team of patient care pharmacists is also here to chat whenever questions come up.

Switch to a better pharmacy for free same-day delivery and support with insurance and savings opportunities. Reach out any time through in-app messaging or by phone at 1-800-874-5881.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable.

Prioritize Your Health with Preventative Care

If you’ve ever waited until you’re sick to see a doctor, you’re not alone. Many adults in the U.S. put off routine doctor’s appointments — sometimes even when they don’t feel well. 

These delays can be serious: according to the Centers for Disease Control and Prevention, up to 40% of all fatalities linked to the five leading causes of death in the U.S. — heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries — could have been prevented. Untreated blood pressure or cholesterol and unhealthy lifestyle habits factors heavily into many of these cases.

Practicing preventative health is critical to detecting health issues early on, when they are more treatable, and lowering your risk of developing conditions that are otherwise avoidable. Preventative care involves a combination of annual check-ups, vaccinations, screenings, and healthy lifestyle habits. 

If you haven’t been to the doctor in a while, don’t get discouraged. The important thing is to get back in the habit. Below is an overview of preventative care for both men and women, with recommendations from our pharmacists for how to ensure you’re prioritizing your health.

There are several important numbers that help your doctor understand your risk for health conditions such as heart disease and diabetes: your body mass index (BMI), blood pressure, cholesterol, and glucose levels.

Being overweight or obese increases your risk for many different health conditions, including high blood pressure, unhealthy cholesterol levels, type 2 diabetes, heart disease, and stroke. 

Body mass index (BMI) is a screening tool that doctors use for obesity. A healthy BMI is typically between 18.5 to 24.9, while a BMI between 25 to 29.9 is considered overweight and a BMI of 30 or higher is obese.

Keep in mind that while a BMI does help doctors understand your general risk for the chronic conditions mentioned above, it is merely a snapshot of your health and doesn’t account for other important health factors including age and genetics. Your healthcare provider can help you understand your overall priorities with preventative care beyond any single number, which is another important reason to stay up to date with doctor’s appointments.

Your blood pressure numbers are one of several factors that can help your doctor predict your risk for heart disease and cardiac events like a heart attack or stroke. There are five different blood pressure ranges recognized by the American Heart Association:

If your blood pressure is in the normal range, you should get screened at least once per year. If your blood pressure is in a higher range, consult with your doctor about recommended screening frequency.

Read our previous blog to learn more about managing blood pressure.

A cholesterol blood test, also called a lipid profile or lipid panel, gives results for several different readings: HDL (good) cholesterol, LDL (bad) cholesterol, triglycerides, and total blood (or serum) cholesterol. Your total cholesterol and HDL cholesterol levels are particularly important in helping your doctor identify if you are at risk for a heart attack or stroke.

A healthy range for total cholesterol is considered to be less than 200 mg/dL

A healthy range for HDL cholesterol is considered to be higher than 40 mg/dL for men and higher than 50 mg/dL for women

A healthy range for LDL cholesterol is considered to be less than 100 mg/dL

These targets are intended to be general guidelines, and each individual’s health needs are different. Having type 2 diabetes, smoking, being overweight, and not getting enough physical activity can affect your cholesterol levels. Your healthcare provider can help you determine your personal targets.

If your total cholesterol is under 200 mg/dL, you can have your cholesterol checked every 4-6 years. If you are at higher risk for heart disease and stroke, consult your doctor about recommended screening frequency.

Your blood glucose numbers can help your doctor determine if you have diabetes or are at risk for developing it. A blood sugar level under 140 mg/dL (7.8 mmol/L) is typical considered healthy, while a reading between 140 and 199 mg/dL (7.8 mmol/L and 11.0 mmol/L) may indicate prediabetes and a reading over 200 mg/dL may indicate diabetes. A discussion of these numbers with your healthcare provider is required for an official diagnosis of diabetes.

Generally speaking, if your blood glucose numbers are under 140 mg/dL, you should get screened at least every three years. If you have prediabetes you will need more frequent screening.

If you have diabetes, your healthcare provider can help you develop individualized targets for healthy blood sugar levels, which may be different from the numbers above. Try not to worry about what “normal” looks like for other people, and focus instead on taking simple actions to control your diabetes and live your healthiest life, like staying active and quitting unhealthy habits.

You should have an annual check-up once per calendar year. This appointment is the foundation of preventative care: since each individual’s risk for specific preventable health conditions may vary, discussing your personal health history and vital signs with your doctor will help you determine which preventative measures to prioritize.

In addition to checking with your physician about which vaccines, screenings, and medical tests you need, ask if your family history indicates an increased risk for any health conditions.

Prevention and screening become more important as you age. Regular colorectal cancer screening is recommended for everyone 50 and over. If you have risk factors like an immediate family member with colorectal cancer, your doctor may suggest earlier screening.

The American Cancer Society recommends annual mammograms for all women between 45 and 54. Some women begin screening for breast cancer as early as age 40 depending on their risk and family history. Women 55 and older can continue with yearly mammograms or switch to every two years. Your doctor can help you determine the right screening frequency for your individual needs. 

Preventative health doesn’t just happen in your doctor’s office. Everyday choices like what you eat and how often you exercise can protect your health for years to come.

Staying active is one of the most important things you can do to prevent cardiovascular disease and maintain a healthy weight. If you’re just starting to figure out your ideal exercise routine, know that you don’t have to exert yourself too hard to reap the benefits of physical activity. Even just 30 minutes of moderate exercise most days of the week can help strengthen your heart.

Everyone should do their best to limit their intake of the following foods, but it’s especially important if you face a greater risk for heart disease or diabetes:

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