Cancer | Prevention | Smoking
April 2, 2018

Who should be screened for lung cancer?

by An older woman gets a hug from a girl standing behind her.

This painless scan can pick up lung cancer early, when it’s easiest to treat.

 

Lung cancer is the most deadly cancer in the United States – but high-tech imaging now lets smokers get checked for early signs of lung cancer. Finding lung cancer in its earliest stages makes it far easier to treat.

Screening for early lung cancer uses a fast, painless computed tomography (CT) scan. The scan produces a nearly 3-D image of the lungs, to reveal nodules as small as 1 millimeter, the thickness of a grain of rice.

Longtime smokers are at high risk for lung cancer. Medicare and some private insurance cover the cost of this lung screening, if you meet all these criteria:

  • Age 55 to 80.
  • A 30 pack-year smoking history – that is, smoking one pack of cigarettes per day for 30 years, or the equivalent (for example, smoking half a pack for 60 years), whether you’re still smoking or if you quit in the past 15 years.
  • No symptoms of lung cancer. Symptoms include fever, unexplained weight loss, coughing up blood and painful breathing.

These criteria are based on a study, published in the New England Journal of Medicine in 2011, of more than 50,000 smokers nationwide.

The study screened them for lung cancer, with some people being checked with a conventional X-ray and others with a CT scan. The study followed the group for six years. It found that the people receiving CT scans were 20 percent less likely to die during the six-year period of the study than those who were scanned with conventional X-rays, because the CT scan detected nodules earlier.

The purpose of the screening is to detect any lung cancer before it can grow and spread, so that it is easier to treat. Alexis Paulson, nurse practitioner and clinical coordinator of the Vanderbilt Lung Screening Program, meets with people at the beginning of their screening appointment to explain the scan, and what happens next if it detects a suspicious nodule, an abnormal mass in the lung.

The vast majority of people screened at Vanderbilt – about 96 percent — do not show any signs of suspicious nodules, Paulson said. Of the small group who do, the program typically recommends that they return for another scan within a few months. And of those suspicious-looking nodules, only a small percent are cancerous. Thus, for most people, a lung screening is merely a brief annual check. For others with potentially problematic results, the next step is usually more imaging tests – not a biopsy or invasive procedure — to monitor the nodule to see if it grows.

Paulson encounters some people who are reluctant to be screened. Some worry the scan will reveal lung cancer, she said. Others fear that a positive result (one showing a suspicious growth) will prompt scolding and guilt trips from loved ones who have asked them to quit smoking.

The numbers should reassure most people, Paulson said. As for their families’ reactions, regardless of whether someone is smoking or has quit, if they do have lung cancer, finding it as early as possible makes it easier to treat, possibly without chemotherapy or radiation. For people at high risk for lung cancer, lung screening is inappropriate only for those who truly have no intention of treating the illness, for whatever reason, if they are diagnosed.

Living with Cancer, Screening, Smoking

Older African American man carries a young boy on his shoulders outdoors on a sunny day.

If you meet the criteria for lung screening, ask your primary care provider to refer you for lung screening. If you do not currently have a healthcare provider, Vanderbilt’s program can help you. For more information, visit www.VanderbiltLungScreening.com or call 615-205-9526.

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