For many people, taking a diagnostic exam can be a daunting undertaking, especially when it concerns lung cancer or even the suspicion of lung cancer. According to the National Cancer Institute, one in 16 people will be diagnosed with lung cancer in their lifetime. Furthermore, lung cancer is the number one leading cause of cancer deaths in the U.S. among men and women. The recommended screening test for lung cancer is the low-dose CT scan (LDCT), in which a patient is scanned using low doses of radiation to produce detailed images of the patient’s lungs.
“The low-dose CT of the chest is a lung cancer screening test, just as a mammogram screens for breast cancer and a colonoscopy screens for colon cancer,” said TPMG Pulmonologist, Agnieszka E. Petersen, MD. “We check healthy patients to screen in order to detect cancer early, though most patients screened do not have lung cancer.”
The U.S. Preventative Services Task Force, a national panel of experts, recommends LDCT, a test that has been proven an effective method to reduce mortality in patients with lung cancer.
Patients Eligible for a Lung Cancer Screening
To be considered eligible, you must meet the following criteria:
- Ages 55-80 years old (covered by most private payers and recommended by the U.S. Preventive Screening Task Force)
- Ages 55-77 years old (covered by Medicare/Medicaid)
- Currently smoking or has quit within the last 15 years
- Has a smoking history of 30-pack years or more
- Heavy tobacco smoking
- Exposure to secondhand smoke
- Exposure to radon or asbestos
- Family history of lung cancer
- Chronic lung diseases
What to Discuss with Your Doctor
If your doctor has recommended a lung cancer screening, you will begin smoking cessation counseling, which includes a discussion regarding the need for the test, eligibility, pros and cons, potential results, and follow-up.
Like all screenings, there are potential risks that need to be taken into consideration. Risks include overdiagnosis, cumulative nature of radiation exposure over time, and potential for false positives. If the test produces abnormal results, it does not necessarily mean the patient has lung cancer. Further testing would be discussed and could include both invasive and non-invasive types of testing. The American College of Radiology recently created a new standard for LDCT screenings called Lung-RADS (Lung Imaging and Reporting Data System), which has resulted in a reduction of false positives, as well as fewer unnecessary procedures.
The most significant benefit of a lung cancer screening is the likelihood of detecting a cancerous nodule in the earlier stage. With early detection, a patient can then begin treatment immediately. Research indicates that as a result of discovering the illness early, the mortality rate of asymptomatic patients who had a lung cancer screening test was significantly lower than those who did not have the screening.
What to Expect During the Lung Cancer Screening
The screening test itself is relatively simple and takes about 10-15 minutes to complete. The experience is very similar to a standard CT scan, but there is no contrast (dye) given, and no fasting is required. An LDCT scan is performed by a certified radiologist in an imaging facility. Before the scan, you will be asked to remove any metal from your body, including jewelry, watches, etc. Once the test is completed, you can go about your normal day and your doctor will contact you with the results.
Patients are often concerned about the amount of radiation during the CT scan; however, the radiation dose from an LDCT is, on average, 75% less than that of a traditional CT of the chest. Despite having a low dose of radiation, it still provides a detailed picture of the patient’s lungs.
The LDCT is sometimes requested by patients experiencing respiratory symptoms such as a cough, shortness of breath, or chest pain. However, patients that suffer from these symptoms could be provided with a different type of CT of the chest, rather than the LDCT, which is specifically for asymptomatic patients.
Understanding Screening Results
The results from your screening will either be negative, indeterminate, or positive. Depending on your results, your physician will decide if more tests are necessary. If nothing is found, you will continue with yearly screenings until advised by your provider. False positives occur in around 12 to 14 percent of patients; this means something was found, but no clear evidence of cancer. In this case, you would continue with yearly screenings or your healthcare provider may order additional tests to check on your lungs sooner. If results are positive, you may need further tests, such as a PET scan or biopsy. Your doctor may also refer you to a specialist.
Most private insurers cover an annual exam for patients 55 to 80 years old. Your healthcare provider may be able to help you understand your coverage options. It’s important to note additional diagnostic testing requiring follow-up exams in 3 to 6 months may require copays or out-of-pocket costs.
While taking any type of test can be nerve-wracking, it is normal to have anxiety around lung cancer screenings. Nevertheless, it is important to note that approximately 86% of people screened for lung cancer come back with negative results. With that said, it is important to understand that a positive screening does not always indicate cancer. If a patient comes back with a positive screen, the nodules found may be benign (non-cancerous) or cancerous. For any positive screening, further testing will be completed to determine if cancer is present.
Your healthcare provider is your most excellent resource and will help you choose the best path moving forward. Talk to your primary care physician today to see if a lung cancer screening is right for you.
About Agnieszka Petersen, MD
Board certified in pulmonary, critical care, and internal medicine, Agnieszka E. Petersen, MD, specializes in the treatment and management of disorders of the respiratory system including the lungs, upper airways, thoracic cavity, and chest wall. As a pulmonologist, she seeks to educate her patients on their specific conditions by developing comprehensive treatment plans and providing compassionate care using the latest medical evidence and research available in pulmonary medicine.
Dr. Petersen joined TPMG Lung & Sleep Specialists in August 2019 and sees patients at the Newport News and Suffolk locations.