According to the National Cancer Institute, approximately 70% of lung cancer patients are initially diagnosed with advanced-stage disease, which is more difficult to treat than early-stage cancer. Patients who are current or former smokers may be eligible to get regular lung cancer screenings to monitor their lungs for disease. By taking advantage of regular lung cancer screening, the hope is that we can catch lung cancers earlier, when they are the most treatable.
LUNGevity Foundation spoke with Robert Keith, MD, professor of Medicine – Pulmonary Sciences and Critical Care at the University of Colorado and member of LUNGevity’s Scientific Advisory Board, to understand how to interpret the results of lung cancer screening and to answer other important questions.
What is lung cancer screening?
Lung cancer screening is a way to monitor patients for lung cancer. Ideally, a patient who is at high risk for lung cancer and meets the eligibility guidelines would have an annual low-dose CT scan of their lungs to look for changes in their lungs over time.
Who should be screened?
There are screening guidelines based on scientific data to help us make sure that we are screening the patients who are most likely to benefit from screening. The guidelines can be found here. Keep in mind that these guidelines can be updated as research reveals more about lung cancer and lung cancer screening. So, if you or someone you know is at increased risk for lung cancer, make sure you are following the most up-to-date guidelines.
What should patients expect during a lung cancer screening?
First of all, it’s not painful or invasive. For the patient, it’s similar to getting an X-ray, although the technology is different. You just lie down on the table, do what the technician tells you, and then let the machine take the images. However, it’s important to have a measured approach to the results of lung cancer screening.
How should patients interpret the results of lung cancer screening?
It’s important that patients stay calm and understand that the vast majority of lung nodules that are found on low-dose CT scans are benign, but we wouldn’t be doing our job if we didn’t pay close attention to each one.
What happens if an abnormality is found during lung cancer screening?
Again, finding nodules is very common during lung cancer screening. Once we find one, we have to consider the size, appearance, and location of the nodule to guide us in our next steps. We also consider other things such as family history and possible environmental exposure.
In some cases, we may decide to do a biopsy immediately. Other situations may allow us to wait and do follow-up scans in three months or six months or a year. Whenever possible, I like to be able to compare current scans to previous scans to see if the nodule is growing or changing over time.
How do we know lung cancer screening works?
The NELSON trial is a long-term study that looked at the effects of regular lung cancer screenings. The 10-year follow-up results for the 15,000 individuals enrolled in the trial showed a significant reduction in lung cancer-related mortality for those who were regularly screened for lung cancer compared to those who were not screened.
What about light smokers or people who don’t fit the eligibility criteria? What should they do?
First and most important: Quit smoking! There are many successful smoking cessation programs that can help. Beyond that, I would say that if you don’t meet the screening eligibility criteria, you should talk to your doctor about your options. Make sure to be an advocate for yourself--learn about your family history of disease and pay attention to your body.
Juhi Kunde, MA, is a science writer for LUNGevity.