Who should be screened for lung cancer?
There are several sets of guidelines, including the ones outlined below, to help determine who should be screened by LDCT for lung cancer. These guidelines are primarily based on active (current or prior) tobacco exposure. The guidelines have been established in large part from the results of the National Lung Screening Trial (NLST). They are very similar, with the differences primarily related to the role of screening for the oldest patients and risk factors other than smoking. All of the patients who are recommended for screening are considered to be at high risk for developing lung cancer but do not currently have any symptoms to suggest that they do have lung cancer.
The most common guidelines for annual screening with LDCT is for adults who are:
- aged 50 years and over
- have a 20 to 30 or more pack a year smoking history
- have risk factors other than second-hand smoke
- are current smokers or quit smoking within the past 14 to 15 years
Patients should discuss these guidelines with their doctor and understand the risks and benefits before undergoing LDCT screening.
RELATED: 5 Ways to Keep Your Lungs Healthy
Choosing a screening center
The NCCN® recommends going to screening centers that:
- Follow an organized plan that is updated to include new technology and knowledge
- Have a high-quality screening program with enough staff and resources
- Are accredited to do CT scans by a certifying organization, such as the American College of Radiology
- Get scans read by an American Board of Radiology board-certified radiologist who is an expert in lung cancer screening
- Offer modern multislice CT equipment (which is able to take multiple images in one rotation of the equipment) that does high-quality, low-dose, and non-contrast spiral CT scans
- Partner with a health center that has experience and excellence in biopsy methods, board-certified pulmonologists (lung doctors), and board-certified thoracic (chest) surgeons who are experts in lung cancer
LDCT Drawbacks and Risks
Despite the benefits of LDCT lung cancer screening, including decreased mortality from lung cancer, decreased mortality from lung cancer treatment, and improved quality of life, there are some drawbacks and risks, including that LDCT may:
- Find abnormalities that have to be checked with either another scan or a biopsy if considered suspicious; the vast majority of the time these end up not being cancerous
- Miss very small cancers or cancers that are hidden behind other structures in the chest
- Expose a patient to a small amount of radiation. While it is a smaller dose than that from a standard CT scan, multiple LDCTs can lead to greater radiation exposure. High doses of radiation exposure can lead to other types of cancer in the future
- Detect tumors that would not become problematic. Such tumors may be indolent (tumors that grow slowly and may not always require treatment)
- Have costs for the patient that are not covered by the patient’s insurance
- Cause stress while waiting for test results
In addition:
- Not all tumors that are found will be at an early stage
- Screening can only be done at facilities that can perform an LDCT, so a patient may have to travel to obtain a screening
When weighing whether or not to get an LDCT, it is important to keep in mind that an LDCT can find other abnormal growths in tissues outside the lungs (incidental nonpulmonary findings). These findings need to be followed up on by your doctor or specialist. You can also follow up with your doctor if you have any additional questions.
This content is brought to you by The Lungevity Foundation and the BDO Editorial Staff.