Finding lung cancer early can save lives. But should you get tested?
Lung cancer is the leading cause of cancer deaths in the United States. In fact, it has one of the lowest survival rates of all cancers: Only 17% of people are alive five years after being diagnosed with lung cancer.
That disheartening stat is due at least in part to the fact that until recently, there was no good screening protocol to detect early-stage lung cancer. Most lung cancers were detected at later stages, which are harder to treat.
“Early detection is incredibly important,” says Mara Antonoff, MD, assistant professor in the department of thoracic and cardiovascular surgery at the University of Texas MD Anderson Cancer Center in Houston. “Stage 1 lung cancer with no symptoms is often curable by surgery alone. With stage 4, the five-year survival is under 5%.”
Now, finding early-stage lung cancer before symptoms show up is possible, with low-dose CT scans, called LDCT.
In 2013, the U.S. Preventive Services Task Force (USPSTF), which issues preventive health guidelines, recommended annual LDCT screening for certain adults at the highest risk of lung cancer. The recommendation came after the landmark National Lung Screening Trial, published in 2011. The research found up to a 20% decrease in deaths from lung cancer among high-risk individuals who underwent LDCT compared to chest X-rays.
So how do you know if you qualify?
The USPSTF guidelines recommend annual screening for adults ages 55 to 80 who have a 30 pack-year smoking history and either currently smoke or have quit within the past 15 years.
In case you’re not familiar with the concept of a pack-year, it’s a way of measuring how much someone has smoked over a lifetime. It’s calculated by multiplying the number of packs of cigarettes smoked per day by the number of years the person smoked, according to the National Cancer Institute. A 30 pack-year smoking history could mean someone smoked one pack a day for 30 years, two packs a day for 15 years, or three packs a day for 10 years, for example.
Other organizations, including the American Cancer Society, issued the same or similar recommendations soon after, and most private insurers started covering the screening. Medicare jumped on the bandwagon in 2015.
“All the criteria revolve around age and smoking history,” says Albert A. Rizzo, MD, senior medical advisor for the American Lung Association and section chief of pulmonary medicine at Christiana Care Health System in Newark, Delaware. Those are the two main risk factors for lung cancer.
There are other risk factors for lung cancer, including exposure to asbestos, radon, and secondhand (or even third-hand) smoke. Currently, those risks are not included in screening recommendations or covered by insurance. If you and your doctor decide you should get screened for lung cancer but you don’t fit the eligibility requirements, you can expect to pay around $300 out of pocket, says Dr. Rizzo.
The actual scan is as painless as a mammogram, maybe even more so. You lie on your back on an examination table with your hands above your head, then hold your breath for five to 10 seconds while the table moves through the scanner. The scanner takes multiple pictures with a relatively low dose of radiation. The whole ordeal “usually takes less than five minutes,” Dr. Antonoff says. Experts recommend that the screening only be done at centers that have specialized scanners and experience with the procedure.
The scans won’t find every single cancer, and they won’t find every single cancer early–but they do find many. About a quarter of LDCT scans in the National Lung Screening Trial found something abnormal. Most of those abnormalities aren't cancer; in fact, more than 96% turned out to be no big deal. However, you’ll still have to undergo additional scans or tests including, sometimes, an invasive procedure like a biopsy, to know this for sure.
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Your best defense against lung cancer is to quit smoking. The USPSTF recommends that you stop annual screening once you haven’t smoked for 15 years. But if you still smoke or quit more recently, talk to your doctor about LDCT screening.
Of course, be on the lookout for symptoms of lung cancer like a persistent cough, shortness of breath, fatigue, chest pain that gets worse when you cough or laugh, infections that don’t go away, and wheezing. “Anyone who has concerning symptoms needs to be evaluated,” says Dr. Antonoff.