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Screening for Early Lung Cancer

Medically reviewed by Mark Levin, M.D.
Written by Emily Wagner, M.S.
Posted on November 8, 2021

Several types of cancers have effective screening approaches that are used to regularly check people who are at high risk for developing those cancers, including mammograms for breast cancer and colonoscopies for colon cancer. A low-dose computed tomography (CT) scan is a screening that can be done for people who are at an increased risk of developing lung cancer.

Benefits of Early Lung Cancer Screening

Lung cancer is the second most common type of cancer in the United States for both men and women, and it is the leading cause of cancer deaths. Lung cancer is best treated when it is found at an early stage, when the cancer is still localized (stage 1 lung cancer in non-small cell lung cancer or limited-stage cancer in small cell lung cancer).

Unfortunately, less than 20 percent of lung cancers are diagnosed before the tumor has spread. At an early stage, many people do not experience any symptoms of lung cancer, making detection even more difficult. Early lung cancer screenings that can help catch cancer before symptoms develop offer the best chance of diagnosing and treating cancer early.

Not everyone will benefit from screening — for example, screening won’t identify all types of cancer in their early stages. Guidelines also advise what ages and what kind of smoking exposure qualify people for lung cancer screening. If you are at an increased risk for lung cancer, talk to your doctor about early screening and if you qualify.

How Is Early Lung Cancer Screening Done?

Early screening for lung cancer is done using a low-dose CT scan (LDCT), also known as a helical CT scan or a low-dose spiral CT scan. The LDCT scan exposes you to less radiation than a traditional CT scan and does not require contrast dye. The LDCT is highly sensitive and can create detailed images of the lungs to look for abnormalities.

The National Lung Screening Trial and LDCT

The National Lung Screening Trial (NLST) was a large, randomized clinical trial that studied the difference between low-dose CT and X-ray as screening methods for lung cancer.

The NLST included more than 50,000 people between the ages of 55 and 74 who had currently or previously smoked and were generally in good health, without symptoms of lung cancer. In order to be eligible for the study, the participants had to have at least a 30 pack-year smoking history.

Overall, the study found that people who were screened using LDCT were 20 percent less likely to die from lung cancer than those who had chest X-rays.

CT scans can be used to take detailed images of the chest and are better for finding small, abnormal spots in the lungs compared to chest X-rays. The study also found that specific subtypes of non-small cell lung cancer, such as squamous cell carcinomas and adenocarcinomas, were more likely to be detected early using LDCT compared to chest X-rays. On the other hand, small cell lung cancers are much more aggressive and less likely to be detected early by either LDCT or chest X-rays.

Who Is Eligible for Early Lung Cancer Screening?

Screening is typically recommended only for people who are at a high risk of developing lung cancer. The people who are at the highest risk are current smokers and former smokers who have smoked a certain number of cigarettes per year. Smoking history is quantified using pack-years. One pack-year is equivalent to smoking one pack (20 cigarettes) per day for one year. For example, a 30 pack-year smoking history can mean a person smoked one pack a day for 30 years, or two packs a day for 15 years.

Several organizations have developed guidelines indicating who should be screened. These guidelines rely mainly on the results from the National Lung Screening Trial.

U.S. Preventive Services Task Force Guidelines

The U.S. Preventive Services Task Force (USPSTF) recommends annual screenings using LDCT for adults who meet all of these criteria:

  • Are between 50 and 80 years old
  • Are currently smokers or former smokers who quit in the last 15 years
  • Have a 20 pack-year smoking history

The USPSTF recommends stopping lung cancer screening once a person meets any one of these criteria:

  • Reaches 81 years old
  • Develops a terminal health condition
  • Cannot undergo lung surgery to treat cancer for medical reasons
  • Has not smoked in 15 years

American College of Chest Physicians

The American College of Chest Physicians recommends annual screening with LDCT for adults who meet all of these criteria:

  • Are between 55 and 77 years old
  • Have a 30 pack-year smoking history
  • Have continued smoking or have quit within the last 15 years

National Comprehensive Cancer Network

The National Comprehensive Cancer Network divides its recommendations for annual lung cancer screening with LDCT into two groups for adults who are either:

  • Between the ages of 55 and 77
  • Have a 30 pack-year history or more
  • Still smoke or have quit within the past 14 years

Or:

  • Are ages 50 and over
  • Have a 20 pack-year smoking history
  • Have risk factors other than secondhand smoke

Other risk factors that increase your risk of developing lung cancer include exposure to asbestos, having a family history of lung cancer, and having chronic obstructive pulmonary disease.

Lung Cancer Screening Tests and Their Results

Your LDCT scan will be performed and then analyzed by a radiologist, a doctor who specializes in reading imaging tests. If they do not find any abnormalities, your doctor will likely recommend you continue annual screening tests to monitor your lungs.

The radiologist may also find lung nodules, which look like small spots in the lungs. These nodules are not always cancer and could be from other conditions, such as benign (noncancerous) growths or scarring from past infections.

Fortunately, only around 4 percent of lung nodules found in screenings are cancerous. Many small nodules can be monitored with annual screening. In some cases, your doctor may ask you to return for a scan in a few months to check if the nodule has grown, which may be a sign of cancer. Then, it would be biopsied to find the definitive answer.

If your scan shows larger nodules, you may be referred to a pulmonologist — a doctor who specializes in the heart and lungs. This doctor can perform additional tests on the nodule, such as a biopsy, to see if it is cancerous. A biopsy involves removing a piece of the nodule and looking at it under a microscope for cancer cells.

Talk With Others Who Understand

MyLungCancerTeam is the social network for people with lung cancer and their loved ones. On MyLungCancerTeam, more than 3,000 members come together to ask questions, give advice, and share their stories with others who understand life with lung cancer.

Have you had an early lung cancer screening? Share your experience in the comments below, or start a conversation by posting on MyLungCancerTeam.

Posted on November 8, 2021
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Mark Levin, M.D. is a hematology and oncology specialist with over 37 years of experience in internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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