Lung Cancer Screening

Many of my close friends’ parents and grandparents smoked cigarettes. In their generations, smoking was a part of the culture. Although the dangers of cigarette smoking were known, smoking was still widely accepted in society. It was not too long ago when we could smoke cigarettes at work, on planes, and even in hospitals! Longtime smokers are predisposed to develop lung cancer and it is now common to screen high-risk patients using CT scans.

According to the Centers for Disease Control and Prevention, people who smoke are 10 to 20 times more likely to develop lung cancer or die from lung cancer than people who do not smoke. The longer a person smokes and the more cigarettes smoked each day, the more that risk increases. Let us put this in perspective: in the United States, about 90% of lung cancer deaths in men and almost 80% of lung cancer deaths in women are caused by smoking. This year 157,000 people are expected to die from lung cancer, which is more than the deaths from colorectal, breast, pancreatic, and prostate cancers combined. As with all cancers, early detection is key to survival.

Q: What is lung cancer screening?

A: There are many screening tests in medicine. Breast cancer screening is performed yearly using mammograms. Colon cancer screening is performed using colonoscopy. The goal of all screening tests is to detect cancer at a very early stage. This gives the patient the highest chance for a 100% cure rate. Screening tests are performed before symptoms of cancer begin. In lung cancer screening, patients who have a high risk of developing lung cancer undergo a low radiation dose computed tomography (CT) scan of the chest.

Q: What is a computed tomography scan of the chest?

A: Computed tomography scan (or CT scan) is a machine that uses x-rays and advanced computer processing to create multiple images of the body in exquisite detail. Low radiation dose CT scan can decrease the amount of radiation a patient receives by up to 60%.

Lung Nodule

5-millimeter lung nodule which is too small to be seen on a traditional chest X-ray. This proved to be cancer.

Q: Why can’t we use chest x-rays for lung cancer screening?

A: Chest x-rays are fantastic to examine the heart, lungs, and bones of the chest. Unfortunately, chest x-rays are not sensitive enough to detect signs of early lung cancer. CT scans are able to find cancers that are as small as 2-3 millimeters. Early cancers this small cannot be reliably detected on chest x-rays.



Q: Who is considered “high risk” for developing lung cancer?

A: Risk factors for developing lung cancer include:

  • Smoking tobacco
  • Contact with cancer-causing agents such as asbestos and radon
  • A personal history of lung cancer from smoking
  • A family history of lung cancer
  • Various chronic lung diseases

Q: Does my health insurance cover lung cancer screenings?

A: Medicare and many insurances will cover low radiation dose lung cancer screening if a person has the following criteria:

  • Ages 55-77 and is either a current smoker or have quit smoking within the last 15 years
  • Tobacco smoking history of at least 30 “pack years”

Q: What is a “pack year”?

A: A pack year is calculated by multiplying the number of cigarette packs a person has smoked per day by the number of years that person has smoked. For example, smoking 1 pack per day for 30 years = 30 pack years. Smoking 2 packs per day for 15 years = 30 pack years.

Q: How often do I need to be screened? What happens if something is detected on my exam?

A: Patients who are high risk for lung cancer should be screened using CT scan once per year. Many small nodules detected on CT screening exams are benign (i.e., not cancerous). Your doctor will recommend following these nodules with serial CT scans over the course of several years. If these nodules do not grow or change in appearance, it can be safely concluded that these nodules are benign. If a discovered nodule looks suspicious or is seen growing over several CT exams, the patient should undergo additional testing (such as a PET/CT scan) or be biopsied.

Q: How much radiation does one receive from a screening CT scan?

A: The latest technology has significantly decreased the amount of radiation emitted from CT screening. Low dose CT chest scan has close to the same radiation dose as a mammogram. A yearly CT scan in an older population has a negligible risk of contracting and dying from radiation-induced cancer. The benefits of screening this high-risk population certainly outweigh the risks of modest radiation exposure.

Q: How much does CT lung cancer screening cost?

A: All CT lung cancer screening tests require a prescription from your doctor. Medicare and many insurance plans will cover lung cancer screening. Some patients do not fit the strict criteria for screening. Perhaps they have a 25 pack year smoking history instead of a 30 pack year smoking history. Some patients want to have a loved one checked for possible cancer. The cost of a CT scan can be over $1000. As a community service, Toms River X-ray, CT, and MRI Center is offering low radiation dose CT lung cancer screening for $200.