Lung Cancer Screening Program

A lung nodule is a spot seen on chest x-rays or CT scans. CT scans are very good at detecting lung nodules. Many lung nodules are found by accident or “incidentally” when a CT scan is done. Lung nodules are very common. 25% of people who undergo screening for lung cancer will have a lung nodule found, but most are not cancers. The evaluation of any nodule should be done thoroughly and carefully.

One of our experienced clinicians, who will go through your history, perform a physical examination, review your radiology studies, and then have an in-depth discussion with you about the possible causes of your nodule. As a team, we will collectively determine what, if anything should be done. Evaluating your pulmonary history and any lung cancer risk factors are important parts of this evaluation.

If our team feels that your nodule is suspicious for cancer, we will work with you and guide you through an appropriate evaluation.

Many lung conditions can leave temporary or permanent spots in the lungs. For example, infections can leave behind scars. These would be just like scars on your skin; they are present but will not cause any harm. Other nodules may be related to current infection or inflammation. The nodule program team will help you understand what the potential causes of your nodule might be, and whether any treatment is necessary.

We are happy to provide second opinions for lung nodules that have been evaluated at other institutions.

The purpose of screening is to detect cancers when they are early, before they cause symptoms. When cancers are detected early, there is a greater chance that treatment will be effective, including a better likelihood of cure. Effective cancer screening reduces the risk of dying from cancer. Screening has been beneficial in improving early detection for lung, breast, cervical, prostate, and colon cancers.

The United States Preventive Services Task Force recommends yearly screening for lung cancer for individuals at increased risk for lung cancer. This recommendation is based on years of clinical research, in particular the landmark National Lung Cancer Screening Trial (NLST). The NLST demonstrated that annual screening for 3 years with low-dose CT scanning resulted in fewer deaths from lung cancer than annual screening with chest x-ray.

Benefits of lung cancer screening, and specifically a decrease in deaths from lung cancer, have been proven for the following people:

Adults between the ages of 50-80 years*, who have smoked the equivalent of one pack of cigarettes a day for at least 20 years, and who are currently smoking or have quit smoking within the past 15 years.

*Medicare coverage up to age 77

Smoking is by far the strongest risk factor for developing lung cancer. There are also many other risk factors. Hereditary factors are important (i.e. having a close relative who has had lung cancer). Occupational or domestic exposures to carcinogens such as asbestos or radon contribute to risk. The presence of lung problems such as COPD or interstitial lung disease also increases lung cancer risk. Exposure to second hand smoke has an effect, although it is small. The assessment of your individual risk for lung cancer should take all your personal factors into consideration.

When your primary care provider orders a lung cancer screening CT scan, you will be scheduled for a brief counseling visit followed by a chest CT scan. The counseling visit is a requirement by most insurers. During this visit you will receive a detailed assessment of your personal risk for lung cancer, and you will have a discussion with the practice nurse about the potential benefits and downsides of lung cancer screening. This is important for ensuring you have the right information to make a thoughtful and informed decision about having the screening test done. We will explain the process of the initial chest CT scan as well as any future screening. When your chest CT scan is completed, the results will be sent to your primary care provider.

Preventing lung cancer is better than finding it early. Smoking remains the most significant risk factor for lung cancer, and one that can be changed. The most important thing you can do to prevent lung cancer is to not smoke. Quitting smoking is difficult, but methods to help accomplish this have become quite sophisticated and successful, with data showing that a program tailored to an individual can help increase the likelihood of quitting. The Yale Tobacco Treatment Program, our clinical partner, is a state-of-the art program that offers personalized smoking cessation treatment. You can contact the Yale Tobacco Treatment Program at (203) 688-1378 or by email at [email protected].

The risk you have accumulated by smoking never completely disappears, but quitting helps decrease that risk. However, quitting will help decrease your risk. How much risk you have depends on many factors such as how many years you smoked, how many cigarettes you smoked per day, and at what age you started to smoke. It is important to remember that there are many benefits to quitting smoking that are just as important as decreasing your risk from dying of lung cancer, including decreasing the risk of heart attack and stroke.

Screening with chest CT is not recommended in individuals who have never smoked, because in general their risk of developing lung cancer is very low. It is important to know that there are many other risk factors for developing lung cancer besides smoking, and individuals who have never smoked can still develop lung cancer, though this is uncommon. If you have never smoked, but are concerned about your risk for lung cancer, we can offer you an individualized assessment to help guide you in making the right decision about whether to undergo screening.

Lung cancer screening can reduce your risk of dying from lung cancer. Screening certain people who are at an elevated risk of developing lung cancer can prevent 1 in 5 deaths from lung cancer. CT scanning allows us to detect early lung cancers that cannot be identified by chest x-ray. If you are screened and are found to have lung cancer, it is more likely it will be at an early stage.

Screening does not do anything to change your likelihood of developing lung cancer; its only purpose is to detect lung cancer earlier than would otherwise be possible. That is why modifying any risk, and in particular quitting smoking, modification is so important. It is also why you cannot be screened once or twice and then stop.

There are drawbacks to screening due to the possibility of findings that are not cancer, but may cause clinical concern and/or more testing. We know that people who have smoked often have abnormal findings on their screening chest CT scans. We also know that, while the vast majority of these findings are not cancers, more testing, sometimes including a biopsy or surgical removal, may be required in order to determine whether the finding is cancer or not. When these tests are ordered and used appropriately and in the right setting by experienced clinicians, the risks of additional testing are low. Stated simply, you do not want to have any tests that you do not need; on the other hand if you do need them you want to be confident that they will be done well and for the right reason.

Screening chest CT scans are done with low doses of radiation, considerably less than a regular CT scan. The risk related to the small amount of radiation from the screening test is far outweighed by the overall benefit in decreasing lung cancer deaths. However, radiation doses can add up, and so the decision to perform scans should be done thoughtfully. The quality of the radiology interpretations of the screening CT scan is important, as is the structured process for properly determining when additional scans are needed and when they are not. When done in an organized approach, the risk related to radiation from screening is extremely low.

Screening CT is so sensitive that it detects small lung abnormalities in approximately 25% of people undergoing screening. More than 95% of these abnormalities are benign, and are NOT cancer. Proper interpretation of the scan is extremely important. You do not want to worry unnecessarily about a nodule that is not a cancer and not of any clinical significance; on the other hand a potentially concerning abnormality, no matter how small, warrants appropriate attention.

A lung nodule is a “spot” seen on the CT scan. Lung nodules are found in about 25% of people who have a screening study, but it is important to emphasize that the vast majority of these nodules are NOT cancers. Because it is so important that these nodules be evaluated properly, to identify as best as possible the few that may be concerning for cancer from the many that are not, we have developed the Yale Nodule Program. We will meet you, evaluate your risks, review your scan with our expert team, and have a full evaluation and discussion with you. We can explain the possible causes of your nodule(s) and what (if anything) further should be done.

Individuals come to the screening program because they are worried about developing lung cancer. Since screening CT frequently finds small nodules that are NOT cancers > 95% of the time, you want to be screened in a program that carefully sorts out the nodules that are nothing from the nodules that are something to worry about. Being in a program with clinicians who can explain the findings to you and give you reassurance, or who can take you carefully through an evaluation for a nodule that is concerning, is very important.

Most insurers cover lung cancer screening for individuals who qualify. Medicare covers the initial lung cancer screening counseling/decision support visit and annual low dose Chest CT as a preventive service benefit. There should be no co-pays or deductible applied. Check with your insurance carrier regarding your individual benefits.