Lung Cancer: Early Detection
Screening is the process of looking for cancer in people who don’t have symptoms. Your healthcare provider may recommend screening if you have an increased risk for lung cancer. Screening can sometimes find cancer early, when it is likely to be easier to treat.
Screening tests for lung cancer
In general, screening is not done for lung cancer. This is because studies have not found that tests such as X-rays or looking for cancer cells in coughed-up mucus (sputum cytology) actually save lives. But the following test may help find lung cancer early.
Low-dose CT (LDCT) scan
This test is also called a spiral CT scan. It uses X-rays to create detailed pictures of your lungs. To have the test, you lie still on a table as it passes through the center of the CT scanner. A CT scan is painless and noninvasive. It does not need any special preparation. You may be asked to hold your breath one or more times during the scan. A CT scan can show some abnormal areas that a chest X-ray might miss. But these areas often turn out not to be cancer. You may still need more invasive tests to be sure.
It’s not clear if spiral CT scans can find cancer in people who are not heavy smokers or who have not smoked at all. It’s also not clear if the test can find cancer in people younger than age 55. Studies of the spiral CT scan have only been on heavy smokers who were 55 to 74 years old.
Spiral CT scans also have some downsides. They find many abnormalities that turn out not to be cancer but that still need more testing to be sure. This can make people feel anxious. It may also mean unneeded tests such as more CT scans. And it might mean more invasive tests such as biopsies or surgery, even when a person doesn't have lung cancer. Spiral CT scans also use a small amount of radiation during each test.
What expert groups recommend
Several groups have issued lung cancer screening guidelines. The groups include the U.S. Preventive Services Task Force, the American Society of Clinical Oncology, the American Cancer Society, and the National Comprehensive Cancer Network. The guidelines vary slightly among groups. But in general, they recommend that people be screened or talk with their healthcare provider about screening if they:
Are 55 to 74, or slightly older. Check with your insurance plan, because some plans may extend the age limit to 77 or even 80.
Are current or former smokers. Former means quitting within the last 15 years.
Have at least a 30 pack-year history of smoking.
Are in good enough health to be helped by screening. This means that if an early lung cancer is found on screening, they would be able to survive lung surgery to remove it.
These groups also generally recommend that screening should be done at a center that has experience with screening. The center should also be able to offer with tests and treatments that might be needed as a result of screening.
Talk with your healthcare provider
If you have risk factors for lung cancer, such as a history of smoking, talk with your healthcare provider about whether lung cancer screening might be right for you. It's important to think about your risk for lung cancer and whether the screening could help you. You should also think about the limits of screening and the risks that might come along with testing.
Another thing to talk about is cost. Not all insurance plans pay for lung cancer screening.
February 24, 2018
Testing for lung cancer in people at high risk. CA: A Cancer Journal for Clinicians. 2013;63(2):118-119
Gersten, Todd, MD,Stump-Sutliff, Kim, RN, MSN, AOCNS