What You Need to Know About Lung Cancer Screening

The earlier you can catch cancer, the more treatment options you have available, and that’s why screening is so important. Just as mammograms help detect breast cancer and colonoscopies help find colorectal cancer, lung cancer screening is a preventive tool to look for signs of lung cancer.

Devon Griep, lung cancer screening coordinator at the Phelps Health Delbert Day Cancer Institute, answers frequently asked questions about lung cancer screening.

Can lung cancer be detected early?

Yes. With early detection, we are able to find lung cancer at an early stage, such as stage 1 or stage 2, when lung cancer is easier to treat and may even be curable. When you start showing symptoms that are characteristic of lung cancer, like chest pain and chronic cough, most likely, your cancer may already be in a late stage. Cancer in stage 3 or stage 4 is less treatable and most likely not curable, depending on the type and the individual.

What is lung cancer screening?

Lung cancer screening is a prevention tool. We identify patients who are high-risk and meet a certain set of criteria. If eligible, you’ll undergo an imaging test – a CT, or computed tomography exam. With lung cancer screening, we try to catch these lung cancers before you start to show symptoms and before you would need some type of extensive treatment.

Who is eligible for lung cancer screening?

We would love to screen everyone and catch all of the early symptoms, but we have certain criteria to identify patients who are high-risk for lung cancer. You are considered an eligible, high-risk patient if you meet the following criteria:

• You’re between the ages of 50 and 80 and have a minimum of 20 pack-years of smoking.
• You must be a current smoker or have quit smoking within the last 15 years.
• Within those 15 years, you must have had no symptoms of lung cancer and must have participated in a shared decision-making visit with your healthcare provider.
• Also, you must have had prior counseling on quitting smoking, if you’re still a current smoker.

What is a pack-year? How are pack-years calculated?

We calculate pack-years by multiplying how many packs of cigarettes you smoked a day by how many years you were consistently smoking. Let’s say, you smoked one pack a day for 20 years. So, 1 pack multiplied by 20 gives you 20 pack-years, which is the minimum requirement. If you smoked two packs a day for 10 years or half a pack a day for 40 years, any combination of the two that equals to at least 20 pack-years qualifies you to be screened.

What is a shared decision-making visit?

When you’re in your doctor’s office, for example, at your annual visit, we call it a shared decision-making visit because it's not just the provider telling you, “Hey, get this done.” You and your healthcare provider are talking about the risks and benefits of lung cancer screening. Your provider also will review the criteria and process. You eventually say, “yes” or “no,” because it’s your health, it’s your care and it’s your decision.

Do you need a referral from your primary care provider for lung cancer screening?

Yes, you need a referral because of the eligibility criteria. The referral most commonly comes from your primary care physician or provider because that's who you most likely see for your annual visit, but any provider can refer you. Some patients have been referred from our oncologists at the Delbert Day Cancer Institute. Some patients may have been seen for prostate cancer or breast cancer, and the provider noted their smoking history and referred them. Our ear, nose and throat (ENT) doctors also have made referrals.

What are the symptoms of lung cancer?

Some of the key symptoms of lung cancer are consistent chest pain, coughing up blood, chronic cough, being hoarse, loss of appetite and shortness of breath. The main reason that you have to be asymptomatic or not have those symptoms to be eligible for lung cancer screening is because when those symptoms start showing, you’re more likely to have a later stage cancer. At that point, we need to move forward with more in-depth diagnostic tests versus just a screening exam.

What is the cost of lung cancer screening? Do insurance companies cover the costs?

If you meet the eligibility criteria for lung cancer screening, Medicare and many private insurance companies cover the cost of lung cancer screening. If you have questions, you should reach out to your insurance company to check your coverage. You can always talk to your providers or Patient Financial Services to discuss self-pay options.

What are low-dose CT scans? Why are low-dose CT scans beneficial to patients?

A low-dose CT, or an LDCT, is a low-dose computed tomography scan that takes pictures of your lungs and the surrounding area. A radiologist will review the images for abnormalities or nodules, which are spots on your lung. The scan takes about a minute. No needles or contrast dyes are used, and no fasting is required beforehand. You go in and lie down on the table and go through the CT scanner. Low-dose CT uses less ionizing radiation than a normal CT scan.

What are the benefits of lung cancer screening?

If you’re screened for lung cancer on a yearly basis, you have a lower chance of death from lung cancer. When lung cancers are caught at an early stage, they're more treatable.

How accurate are lung cancer screenings?

Lung cancer screenings find 80% of lung cancer in early stages. Without the screening, about 70% of cancers are found at a later stage, which requires more extensive treatment, radiation and chemotherapy. Later-stage cancers are less treatable and possibly even not curable.

After a lung cancer screening, how can I get my results?

Through MyChart, the Phelps Health patient portal, you’ll see your screening results on your smartphone or computer instantly. Once the radiologist reads your scans, those results are sent to you.

You also will get a letter in the mail with your results and any next steps, if needed. You also should get a phone call from your referring provider’s office to discuss the results with you. Most people usually get results within 4 business days, which gives the radiologist time to read the images and send a report to the referring provider. Your care team will review the results and make a plan to contact you.

If your results are negative, meaning no cancer or concerning abnormalities are found, you'll return in a year for your next exam, as long as you remain eligible.

If the radiologist notices nodules or some concerns, they will make recommendations to your referring provider about next steps. Some patients may be asked to repeat the scan in 3 or 6 months. Some patients may be referred to a pulmonologist (a doctor who specializes in lung conditions).

What would you say to a patient who is worried or scared about getting lung cancer screening?

Knowledge is power. Whatever result comes from this screening is going to be better for you in the long run. If we find these cancers early, we're going to be able to treat them early. And if your results are negative, we can move forward with smoking cessation (quitting smoking) or other ways to keep you healthy and on the right path. Regardless of what happens today, getting screened is a step in the right direction.