Is Lung Cancer Screening Right for You?

Some people wonder if they should be screened even though they don’t fit the USPSTF criteria. Maybe they are concerned because a parent died from lung cancer. Lung cancer occurs in nonsmokers, too. Other risk factors for lung cancer include the following:

• Hereditary factors (e.g., having a close relative who has had lung cancer)
• Exposure to carcinogens such as asbestos or radon
• Other lung problems such as chronic obstructive pulmonary disease (COPD) or interstitial lung disease
• Exposure to secondhand smoke

Those who don’t fit the USPSTF criteria but feel they have reason to be concerned about lung cancer should discuss the possibility of screening with their primary care doctor, Dr. Tanoue says. Scanning “just to check” isn’t necessarily a good idea, she says. “The potential downsides of screening become magnified if the chance of developing lung cancer is low.” Both doctors and patients would prefer to avoid the radiation found even in a low-dose screening CT if they don’t think screening is necessary.

Perhaps the most important downside is that CT scans are so sensitive—they can pick up small nodules that are best thought of as background noise, Dr. Detterbeck says. The vast majority of nodules will not be cancer, and the American College of Radiology has endorsed a structured reporting system called LungRADS to minimize unnecessary evaluation of very small nodules. For nodules large enough to warrant more evaluation, “careful judgment by an experienced screening and nodule team will be used to figure out which nodules are just noise and which ones require a closer look,” he says.

Most people who have early-stage lung cancer have no symptoms, so it is important to talk to your doctor about chest pain, persistent cough, shortness of breath, hoarseness, coughing up blood or rust-colored sputum, or recurrent illnesses including bronchitis or pneumonia. Persistent symptoms, when related to lung cancer, are more likely to be associated with more advanced disease.  

That’s why screening to catch lung cancer early is so important, Dr. Tanoue says. “When we talk about tumors, we have to talk about staging [which describes the size of the tumor and if it has spread], which is fundamentally how we talk about survival,” Dr. Tanoue says. More than two-thirds of breast cancers are diagnosed at Stage I or II, and many of these diagnoses result from screening mammography, she says. Because of this high rate of early detection, overall breast cancer survival rates are very high. “It’s the opposite with lung cancer—half of patients are diagnosed at Stage IV, and three-quarters at Stage III or IV. We need to find these patients before their cancers spread. So, it’s really clear that we need early detection for lung cancer.”

Drs. Tanoue and Detterbeck emphasize that lung screening works best as part of a comprehensive program. The Yale Lung SCAN team includes pulmonologists, thoracic surgeons, chest radiologists, smoking cessation specialists, and nurse practitioners, who coordinate care. This team provides each patient with a personal lung risk assessment and a discussion of the expected individual benefits and possible downsides of screening. When appropriate, immediate access to the Smoking Cessation Service at Smilow Cancer Hospital at Yale New Haven Hospital is available.

Lung cancer screening LDCTs are read by dedicated chest radiologists. Results then go back to the Yale Lung SCAN team, who ensures that the patient’s primary care provider receives the results, including recommendations for any appropriate next steps. Patients with lung nodules warranting further assessment can be referred for evaluation back to Yale Lung SCAN.

For people who still have questions about screening, the program provides educational materials. Every patient undergoing lung cancer screening through Yale Lung SCAN receives an individual “shared decision-making” visit with the program APRN that includes a calculation of his or her own risk of lung cancer and an opportunity to discuss any particular concerns he or she may have. The visit includes an interactive educational module using an iPad app to help patients gain a clear, straightforward understanding of the benefits and possible risks of screening, and to allow them to fully participate in the decision to undergo screening.

After going through the shared decision-making process, people whose risk is really low, but who are just really worried, generally leave feeling very reassured, Dr. Tanoue says.

“The whole landscape of lung cancer screening is complicated, which is why really good screening requires a comprehensive program that includes the capability of evaluating patients with abnormal findings and treating those with lung cancer effectively with modern, precision therapies,” she says. “We should not just screen everybody regardless of risk or even really low-risk individuals, because we have to consider emotional, physical, and economic costs. Instead, we want to screen people at high risk—that is how we will save lives.”

For more information or to schedule a consultation, call Yale Lung SCAN at 203-200-LUNG (5864).