Lung Cancer Screening
Overview
Lung cancer screening uses a low-dose CT scan to check for signs of lung cancer in people at higher risk, like those who have smoked for many years. Early screening helps doctors find lung cancer before symptoms appear or the disease spreads to other organs. Finding lung cancer early gives people more treatment options and a better chance for longer life.
Key facts about lung cancer screening:
- Finds cancer before symptoms or serious health problems start.
- Focuses on those with increased risk rather than everyone.
- Main test: low-dose computed tomography (LDCT) scan.
- Early action can lower deaths linked to lung cancer.
Groups such as the American Cancer Society and the U.S. Preventive Services Task Force recommend who should get screened. Researchers and doctors continue to improve screening methods and outcomes. Health organizations work together to set best practices for finding both small cell and non-small cell lung cancers.
Purpose of Lung Cancer Screening
Lung cancer screening aims to find cancer in the lungs before symptoms start. Finding cancer early increases the chance of successful treatment. Most often, lung cancer signs only show up when the disease has already spread or worsened. Screening helps lower the risk of dying from lung cancer, especially for people with a history of heavy tobacco use.
Who Is Advised to Get Screened
Screening is mainly for people who are at higher risk. Higher risk usually means a strong smoking history or other risk factors. Below is a table showing who should consider getting a lung screening test:
| Risk Group | Criteria |
|---|---|
| Current or past smokers | 50 years or older; now smoke or quit within last 15 years. |
| Heavy tobacco users | At least 20 pack-year smoking history (packs per day × years smoked). |
| People with other risk factors | Diagnosed COPD, family lung cancer, or workplace asbestos exposure. |
| Prior lung cancer patients | Treated over 5 years ago and no new disease found since. |
| Generally healthy in other ways | Good overall health, able to have surgery if needed. |
Pack years are a useful measure for assessing risk. For example, smoking one pack a day for 20 years, or two packs a day for 10 years, counts as 20 pack years. Screening is not for everyone. If someone has severe health problems, low lung function, or would not benefit from surgery, screening may not help.
People who need constant oxygen, have lost a lot of weight recently without cause, have coughed up blood, or had a chest CT scan in the past 12 months are not ideal candidates for screening. Other risk factors include family history of lung cancer, being exposed to harmful substances like asbestos at work, or having chronic diseases such as COPD.
Key Points
- Most people screened are smokers or former smokers aged 50 or older.
- People who quit smoking more than 15 years ago are less likely to need screening.
- Good overall health is important to make screening helpful.
- History of cigar or tobacco use also counts when looking at risk.
When to Stop Regular Screening
Medical experts do not all agree on the perfect age to end lung cancer screening. In most cases, people continue yearly lung checks until screening no longer helps. Common reasons to stop:
- Developing other serious health issues that make surgery or treatment too risky.
- Poor health or becoming too frail.
- Reaching an age where screening does not lower the risk of dying from lung cancer as much.
It is best to speak with a health care professional to decide when annual screening should end.
Summary Table
| When to Discontinue | Example Factors |
|---|---|
| New serious illness | Heart failure, advanced disease |
| Older age | No set age, but benefits decrease |
| Lost ability | Can’t tolerate lung procedures |
Possible Drawbacks
Lung cancer screening with low-dose CT scans can have several drawbacks. One concern is exposure to radiation. While the radiation level from this type of scan is lower than a standard CT, it still adds to a person’s total lifetime exposure, which can slightly increase the risk of cancer over time.
Follow-up tests may be needed if the scan shows a spot in the lung. These can include further scans or procedures like biopsies. More scans mean more radiation, and biopsies or surgeries have their own risks, such as bleeding or infection.
A big risk with lung cancer screening is finding something that looks like cancer but is not, known as a false positive. False positives can lead to stress, more testing, and even surgery. Sometimes, doctors find spots or lumps that turn out to be harmless.
| Potential Issue | Explanation |
|---|---|
| Radiation exposure | Scan uses low dose, but repeated exposure adds up over time. |
| False positives | Abnormal results may not be cancer, but lead to extra tests. |
| Overdiagnosis | Some cancers found may never cause harm, but lead to unnecessary treatment. |
| Missed cancers | Scans do not always find all cancers and can sometimes miss them (false negatives). |
| Incidental findings | Scans can find other unrelated health issues that may result in more tests or treatments. |
Another risk is overdiagnosis. Some lung cancers grow very slowly and may never cause health problems. However, once detected, people might go through treatment that is not actually helpful and could be harmful.
The scan can also sometimes miss a cancer, known as a false negative, giving someone a false sense of security. Sometimes, incidental findings show up – these are health problems not related to cancer, such as heart or lung conditions, that might lead to further testing or treatment.
Steps to Get Ready
Before an LDCT scan, people should talk to their healthcare professional about any recent cold or infection. If cold or breathing symptoms are present, the scan might be delayed until at least one month after these symptoms go away. This helps reduce the chance of unusual scan results that could lead to unnecessary follow-up testing.
People are also asked to wear clothing without metal. Jewelry, glasses, hearing aids, and dentures should be taken off before entering the scan room. Avoid wearing clothes with zippers, snaps, or underwire bras. Most people will not need to do anything special with food or drink before the test.
Those thinking about quitting smoking can ask about resources or stop-smoking programs. Some insurance plans and Medicare cover lung cancer screening and may help support quitting. Deciding together with a specialist or healthcare professional can make the process safer and more effective.
What You Can Expect
What Happens While Checking for Lung Problems
During a low-dose computed tomography (LDCT) scan, the person lies flat on a table, usually with a pillow for support. The technologist steps into a different area but can still talk and watch the person through a window.
The person needs to remain very still while the table slowly moves through the CT scanner. The scan itself is quick—often less than a minute. The person may hear some knocking or clicking sounds from the CT machine during the process.
For part of the scan, they may be asked to hold their breath to help the computer make detailed pictures of the lungs. The LDCT scan is designed to find lung nodules or early signs of cancer while keeping radiation exposure low. The whole visit often takes about 30 minutes.
What Happens After Your Scan for Lung Health
After the LDCT scan, people can return to their usual activities right away. The CT images go to a computer system, where a chest radiologist reviews them and looks for any signs of lung nodules or cancer. It may take a few days to get the results. The main benefit of this low-dose CT scan is that it can help spot lung cancer early, when treatment can work better.
Screening Outcomes
Screening for lung cancer can reveal several different findings, and each outcome guides what happens next. The main types of results include no issues found, the discovery of lung nodules, or findings of other health conditions.
- If nothing unusual appears on the scan. Doctors usually recommend another screening in a year unless a person’s overall health changes in a way that makes screening unnecessary.
- Detection of lung nodules. Lung nodules are small spots or growths in the lung. They are quite common, especially in people who have smoked. Most spots are harmless and don’t need immediate treatment. The doctor might suggest another scan in a few months to watch for any change in the size of the nodule. If a nodule grows or looks suspicious, the doctor may recommend more tests, such as a PET scan or a biopsy.
| Finding | Possible Next Steps |
|---|---|
| No abnormalities | Annual follow-up scan |
| Small nodule | Repeat scan in a few months |
| Large nodule | Referral for biopsy or PET |
| Suspicious growth | More imaging, possible biopsy |
- Discovery of other health problems. Sometimes, the scan shows other conditions, such as emphysema or heart artery issues. Talk with a healthcare provider to decide if more tests are necessary.
If screening suggests cancer, doctors may order more tests to confirm the diagnosis. Treatment options can include surgery, chemotherapy, immunotherapy, or targeted treatments, depending on the situation.
