Not sure if you need an annual screening for lung cancer? Run through this checklist with your doctor.
Early detection of lung cancer is key for a positive outcome. That’s why regular lung screenings with low-dose computed tomography (LDCT) are crucial for those with a higher risk of developing the disease. But understanding whether you’re in the high-risk category can be confusing.
“It is a conversation that needs to be had with a medical professional who can assess your current health and risk factors, and advise you on whether or not the screening would benefit you,” said Alexis B. Paulson, MSN, APRN, a Radiology Nurse Practitioner and the Clinical Coordinator for the Vanderbilt Lung Screening Program.
With Paulson’s help, we’ve put together this guide to discussing lung screening with your physician.
1. Am I of age where lung screenings should be considered?
Lung screenings aren’t usually recommended until a person who is at a higher risk reaches 50, per the U.S. Preventive Services Task Force guidelines.
2. I’m of age, but am I at a higher risk?
The USPSTF recommends annual lung screenings for those who have a 20 pack-year cigarette smoking history. That means that if you’ve smoked, on average, a pack per day for 20 years or more, you should get annual screenings. Any equivalent also applies. “If they smoked two packs a day for 10 years,” Paulson said, “that would also meet the criteria.” Eligible individuals will also be current smokers or ones who have quit in the past 15 years.
3. I meet the age and smoking history criteria. How long will I need to be screened?
The USPSTF recommends yearly screenings until a person reaches age 80 or has not smoked in the past 15 years. If a patient develops a health problem that significantly limits life expectancy or the individual isn’t willing or able to undergo a surgery or treatment in the event of a cancer diagnosis, the recommendation is to stop screening.
4. I don’t meet the age and smoking history criteria. Should I still be screened?
Most health insurance plans won’t cover screening unless an individual meets the criteria under the USPSTF guidelines. However, patients can pay for the test out of pocket if they prefer.
“We do still screen patients here at Vanderbilt who are under 50 and also patients who don’t meet the smoking criteria if they have a referral from their doctor,” Paulson said. “Even though insurance may not cover their exam, some patients still want to be screened.”
Individuals who have a family history of lung cancer, a history of other cancers, or have been exposed to carcinogens on the job should discuss those additional risk factors with their health care providers. Together you can make a decision about whether screening should be considered. According to the National Comprehensive Cancer Network, carcinogens that target the lungs include the following: silica, cadmium, asbestos, arsenic, beryllium, chromium, diesel fumes, nickel, coal smoke and soot.
Paulson emphasized the importance of keeping your doctor informed about your potential risk factors because the general guidelines for screening could change in the future.
5. Are there any risks to being screened?
“With any tests, there are always risks,” Paulson said. The radiation exposure is low, however. “The thing that we discuss the most in terms of risks with all cancer screenings is the risk of false positives. With lung cancer screening, a positive screening exam usually results in the need for additional imaging, but occasionally it requires biopsies or surgeries where cancer may not be ultimately found.”
The possibility of missing something is also a factor with all tests. Therefore, yearly screenings are crucial for people who are at a higher risk. “That way we can not only reduce the risk of missing something,” Paulson said, “but we can pick up smaller, earlier cancers because they are caught within a year of becoming visible on imaging. If we’re watching with strict surveillance, we have a much higher probability of catching it early, when it’s most treatable.”