Why should I be screened for lung cancer?

Lung cancer is the most common fatal cancer in adults; however, it can be effectively treated if caught in the early stages of the disease. Screening provides an opportunity to identify lung cancer early in high risk patients when the disease is most treatable, before producing symptoms.

The National Lung Cancer Screening Trial (NLST) was the largest study to date evaluating the effectiveness of two different imaging studies (chest x-ray versus chest CT) to detect lung cancer in patients without symptoms. Given the high prevalence of disease, researchers wanted to know if screening saves lives. The initial results of the study demonstrated a 20 percent decrease in lung cancer deaths for high-risk patients who received screening by CT compared to those screened by chest x-ray.

What are the risks of CT lung cancer screening?

CT screening for lung cancer is safe and non-invasive; however, there are some risks associated with the screening.

• Radiation dose: CT screening uses a low dose of radiation in order to produce images of the lungs. Cumulative radiation exposure, even in low doses, can damage cells, which may result in cancer later in life; however, the risk of developing a radiation-induced cancer is extremely low. To minimize the amount of radiation exposure to patients, Duke radiologists utilize a special “low dose” protocol.
• False positives: The NLST found that approximately 25 percent of patients who have CT screening have a “positive” screen, meaning that a nodule is found in the lung. The vast majority of these nodules are benign (not cancer), which means that most positive screening studies will be a “false positive.” Additional testing is often necessary to determine which nodules represent lung cancer.

Do I qualify for a lung cancer screening CT?

Those who are ages 55 to 74, have 30 pack-years* smoking history, and are current smokers or individuals who quit less than 15 years ago

Or

Those ages 50 and older, have 20 pack-years* smoking history, and have one additional risk factor for lung cancer:

• Exposure to radon, asbestos, silica, or other carcinogen
• Personal history of prior lymphoma or smoking-related
malignancy (i.e., head and neck cancer, bladder cancer, etc.)
• Family history of lung cancer
• COPD or pulmonary fibrosis

*Pack-years as defined by the National Cancer Institute are calculated by multiplying the average number of packs of cigarettes smoked per day by the number of years an individual has smoked. The following are all equivalent to a 30 pack-year smoking history:

• 1 pack per day for 30 years
• ½ pack a day for 60 years
• 2 packs a day for 15 years

Your doctor or a member of the staff can assist in determining if CT lung screening is appropriate for you.

What should I expect on the day of screening?

Please arrive 30 minutes prior to your scheduled appointment. When you register, you will be asked to verify your physician and personal information.

Patients initially will be seen by a member of the Lung Cancer Screening Clinic to discuss the CT screening exam and, if you are a current smoker, receive information on smoking cessation.

The lung screening CT will be performed by a radiologist.  The screening does not require blood work or IV placement. The screening takes about 10 seconds, during which an individual is asked to hold his or her breath in order to limit motion of the lungs.

After the screening is completed, patients will meet with a specialist of the Lung Cancer Screening Clinic to receive the results of the screening that same day before they leave the clinic. A letter will also be sent to your referring physician indicating the results of the screening and any follow-up care that has been recommended.

CT screening for lung cancer is currently not covered by most health care plans. However, we recognize the tremendous potential benefit of CT screening for lung cancer, and are therefore offering the service at a discounted price of $400, due at time of screening.

When will I receive my screening results and what do they mean?

After the screening is completed, patients will meet with a specialist in the Lung Cancer Screening Clinic to receive the results of the screening that same day before they leave the clinic. Here are two possible outcomes of the screening:

• Negative screen: A negative screen means that no nodules on the lung were identified. Given that you are still at risk for developing lung cancer in the future, we currently recommend a repeat screening CT annually for three years and a smoking cessation plan. 
• Positive screen: A positive screen means that a nodule on the lung was detected that may require additional follow-up or further testing. If the screening has positive results, a specialist in the Lung Cancer Screening Clinic will meet with you to discuss the appropriate next steps for additional testing or to begin discussion of a treatment plan, if necessary.

Whether your screen is negative or positive for lung nodules, our radiologists may detect other unsuspected abnormalities that may require additional follow-up, such as lesions involving the blood vessels, liver, kidneys, bone, or other structures. Any incidental findings requiring further medical care should be discussed with your physician.

What if I am diagnosed with lung cancer?

Approximately 4 percent of patients with a positive lung cancer screening CT are found to have lung cancer. For such patients, the screening study is the first step in the comprehensive care provided by Duke Cancer Institute’s team of lung cancer specialists.

Duke is one of the top lung cancer treatment centers in the world. If you are diagnosed with lung cancer, a personalized treatment plan will be developed by our experts in thoracic surgery, medical oncology, radiation oncology, radiology, and pulmonology to offer the best course of care.

Learn more about lung cancer:

• Lung Cancer Risk Factors
• Types of Lung Cancer
• Lung Cancer Facts