Sometimes a screening is more complicated than just a scan. Experts hear a wide range of patients’ worries.
Longtime smokers may understandably worry about lung cancer. Now there’s a screening program that provides a fast, easy check for smokers’ lungs. It can catch lung tumors when they’re still tiny enough to be treated easily, so this type of screening is literally a life-saver.
But people who are even the slightest bit worried that they might have cancer can experience a wide range of emotions. Radiologist Kim Sandler, M.D., and Alexis Paulson, radiology nurse practitioner and clinical coordinator of the Vanderbilt Lung Screening Program, said that patients talk through lots of fears before getting screened. Here, Sandler and Paulson describe the emotional aspect of their work and the things that seem to be most often on patients’ minds. Smokers express several common worries:
Will anyone make me feel guilty about smoking?
Some people coming into the lung screening program are reluctant to be screened, Sandler said, because they worry that a positive result (finding a suspicious nodule) will trigger blame.
“They feel they’ve been judged by the medical profession in the past because of their smoking,” she said – or by loved ones. They fear that “if they are found to have lung cancer, that friends and family members are going to say things like, ‘I told you so,’ or ‘I asked you to quit this many years ago’ and ‘this is something that you did to yourself.’”
“We really fight to combat that stigma,” Sandler said.
Screening is not about guilt, she said. It’s meant to catch tumors as early as possible, to make treatment as easy and successful as possible. “The majority of diagnoses we make are in the early stage. The survival ratios are so much higher for early stage than for late-stage cancer.” Some patients can undergo surgery only – no chemo, no radiation – and live many years beyond lung cancer, Sandler said.
Will the doctor pressure me to quit smoking?
Paulson recognizes that not everyone is ready to quit smoking, and she doesn’t load people up with guilt and lectures. They can be screened anyway, without having to quit.
That said, the screening program offers tools and tactics for quitting, including the TN Quitline number (1-800-QuitNow), counseling about cravings and triggers; and quit-smoking products such as the nicotine patch. This program works with hundreds of people trying to quit, because quitting rapidly lowers their risk for lung cancer.
Paulson said people who quit smoking when they start annual lung screenings can almost double their six-year survival rate from lung cancer. Being smoke-free improves overall health and makes it easier to recover from other health problems, too, anything from a knee replacement to oral surgery to the flu.
She recalls many patients who return for their next yearly screening, proud to announce that they’ve quit smoking.
But plenty of patients have told Paulson they’re just not ready to quit. They come back for screening a year later and can take advantage of the help when they’re ready.
I’ve already fought cancer. I don’t want to go through that again.
Because people eligible for lung cancer screening are older adults – ages 50 to 80 – many of them have already experienced cancer. Maybe they survived breast cancer; maybe they’re living with prostate cancer; maybe they’ve watched a relative deal with cancer treatment.
In her conversations with patients, Paulson hears many express dread of treating cancer again. Many are retired, enjoying life and feeling healthy. They’re not sure they’d go through the time and stress of treatment again if they got another cancer diagnosis.
Paulson reassures them that more than 90 percent of screenings reveal no cancer, so most patients will not have to confront another cancer diagnosis. Also, the screening is meant to catch lung cancer in its earliest stage, when it is small and hasn’t spread beyond the lungs. Sandler noted that some patients whose lung cancer is caught at an early stage are treated successfully with only surgery – no chemotherapy, no radiation. So treatment for early stage lung cancer may not be as frightening as some cancer survivors dread.
However, if someone is absolutely sure that they will not treat any new cancer, they are not coerced into the screening, Paulson said.
She and patients address these concerns before screening – “we talk through all of these scenarios, and all the possibilities and the risks and benefits; and help them make an educated decision about what is best for them.”
Enrolling in the Vanderbilt Lung Screening Program provides annual reminders for future screenings and offers help in quitting smoking. Our radiologists are specially trained in reading lung CT scans, so they produce fewer false positive readings than lung screenings at other locations, giving you greater peace of mind. An order from a healthcare provider is needed for lung screening. Talk with your healthcare provider about whether lung screening is right for you. If you do not have a healthcare provider but would like to be screened, call 615-205-9526 for assistance.
Who should be screened for lung cancer? Read more here.
Kim L. Sandler, M.D., is assistant professor of radiology and radiological sciences at Vanderbilt University Medical Center and co-director of the Vanderbilt Lung Screening Program. Her research focuses on outreach for lung screening, particularly for women and minorities, and improving our ability to differentiate benign and malignant lung nodules by combining CT imaging with blood-based biomarkers, machine learning, and radiomic evaluation of pulmonary nodules.