Thinking About Lung Caner Screening

In this post, I’m listing links to references on lung cancer screening. My plan is to do a podcast on the subject. So these are the links. I’ve read them and I’ll be using them to write and record the podcast.

There are pros and cons to entering a lung cancer screening program.  The patient should consider the decision thoughtfully. In the Resources section, are links to decision making tools. And patients considering lung cancer screening should review the pros and cons of lung screening with their physician*.

*Medical decisions are often best made jointly by you and your physician rather than your physician just telling you what he or she thinks you should. This approach is called Shared Decision Making [See my upcoming post Thoughts And Resources On Shared Medical Decision Making.]

The following is from Resource (1) below, Who Should Be Screened For Lung Cancer? from the CDC:

Screening means testing for a disease when there are no symptoms or history of that disease. Doctors recommend a screening test to find a disease early, when treatment may work better.

The only recommended screening test for lung cancer is low-dose computed tomography (also called a low-dose CT scan, or LDCT). During an LDCT scan, you lie on a table and an X-ray machine uses a low dose (amount) of radiation to make detailed images of your lungs. The scan only takes a few minutes and is not painful.

Who Should Be Screened?

The U.S. Preventive Services Task Force recommends yearly lung cancer screening with LDCT for people who—

  • Have a history of heavy smoking, and
  • Smoke now or have quit within the past 15 years, and
  • Are between 55 and 80 years old.

Heavy smoking means a smoking history of 30 pack years or more. A pack year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 30 pack-year history by smoking one pack a day for 30 years or two packs a day for 15 years.

Risks of Screening

Lung cancer screening has at least three risks—

  • A lung cancer screening test can suggest that a person has lung cancer when no cancer is present. This is called a false-positive result. False-positive results can lead to follow-up tests and surgeries that are not needed and may have more risks.
  • A lung cancer screening test can find cases of cancer that may never have caused a problem for the patient. This is called overdiagnosis. Overdiagnosis can lead to treatment that is not needed.
  • Radiation from repeated LDCT tests can cause cancer in otherwise healthy people.

That is why lung cancer screening is recommended only for adults who are at high risk for developing the disease because of their smoking history and age, and who do not have a health problem that substantially limits their life expectancy or their ability or willingness to have lung surgery, if needed.

If you are thinking about getting screened, talk to your doctor. If lung cancer screening is right for you, your doctor can refer you to a high-quality screening facility.

The best way to reduce your risk of lung cancer is to not smoke and to avoid secondhand smoke. Lung cancer screening is not a substitute for quitting smoking.

Risks of Screening

Lung cancer screening has at least three risks—

  • A lung cancer screening test can suggest that a person has lung cancer when no cancer is present. This is called a false-positive result. False-positive results can lead to follow-up tests and surgeries that are not needed and may have more risks.
  • A lung cancer screening test can find cases of cancer that may never have caused a problem for the patient. This is called overdiagnosis. Overdiagnosis can lead to treatment that is not needed.
  • Radiation from repeated LDCT tests can cause cancer in otherwise healthy people.

That is why lung cancer screening is recommended only for adults who are at high risk for developing the disease because of their smoking history and age, and who do not have a health problem that substantially limits their life expectancy or their ability or willingness to have lung surgery, if needed.

If you are thinking about getting screened, talk to your doctor. If lung cancer screening is right for you, your doctor can refer you to a high-quality screening facility.

The best way to reduce your risk of lung cancer is to not smoke and to avoid secondhand smoke. Lung cancer screening is not a substitute for quitting smoking.

When Should Screening Stop?

The Task Force recommends that yearly lung cancer screening stop when the person being screened—

  • Turns 81 years old, or
  • Has not smoked in 15 or more years, or
  • Develops a health problem that makes him or her unwilling or unable to have surgery if lung cancer is found.

Resource (2), Is Lung Cancer Screening Right for Me? A decision aid for people considering lung cancer screening with low-dose computed tomography, is a resource for persons considering lung cancer screening.

Resources:

(1) Who Should Be Screened for Lung Cancer? From the Centers For Disease Control and Prevention, last reviewed Sept 18, 2019.

(2) Is Lung Cancer Screening Right for Me? A decision aid for people considering lung cancer screening with low-dose computed tomography. From The Effective Health Care Program of the Agency For Healthcare and Research Quality, March 2016.

(3) Lung Cancer Screening With Low-Dose Computed Tomography (LDCT) – Lung Cancer Screening: A Summary Guide for Primary Care Clinicians. From The Effective Health Care Program of the Agency For Healthcare and Research Quality, March 2016.

(4) Lung Cancer Screening: A Clinician’s Checklist. [From The Effective Health Care Program of the Agency For Healthcare and Research Quality, March 2016.]:

This checklist was developed to help clinicians meet the Centers for Medicare & Medicaid Services (CMS) criteria for a lung cancer screening counseling and shared decisionmaking visit. All of the criteria listed below [in the resource] must be met for the screening to be covered as a preventive service benefit under Medicare.

(5) Final screening round of the NELSON lung cancer screening trial: the effect of a 2.5-year screening interval [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Thorax. 2017 Jan;72(1):48-56. doi: 10.1136/thoraxjnl-2016-208655. Epub 2016 Jun 30.

 

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