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Low-Dose CT Lung Cancer Screening

By John M. Cain, MD
Radiology Medical Director, Ocala Health

Low-Dose CT Lung Cancer ScreeningLung cancer is the second most common form of cancer in men and women. However, it is the deadliest cancer in both men and women.

Lung cancer causes 30% of all cancer deaths in America. Breast, colon, and prostate cancer have five-year survival rates of 90% or greater, but lung cancer continues to have a five-year survival rate of less than 16%. Lung cancer is common and deadly. The American Cancer Society estimates that 222,500 Americans will be diagnosed with lung cancer in 2017, and 155,870 will die of lung cancer in 2017. Lung cancer kills more people than colon, breast, and prostate cancer combined. One of the reasons for this grim prognosis is that most lung cancers are not detected until it is too late.

Recently, a decade-long study validated a lung cancer screening program that is proven to find cancer earlier when it is still treatable. The study was large, involving 53,454 healthy current or former smokers. The study convincingly showed that one life could be saved for every 1,000 people screened. Low-dose computed tomography lung cancer screening has been approved and recommended by the United States Preventative Services Task Force (USPSTF), The American Cancer Society (ACS), The American College of Chest Physicians (ACCP), and the American College of Radiology (ACR). In February 2015, The Centers for Medicare & Medicaid Services (CMS) approved Medicare and Medicaid payment for the test for qualifying beneficiaries.

Low-dose lung cancer screening is now available to patients at high risk for lung cancer. These patients must meet all of the following criteria:

. Age 55 to 77 years
. Tobacco smoking history of at least 30 pack-years (one pack-year = smoking one pack per day for one year; 1 pack = 20 cigarettes)
. Asymptomatic (no signs or symptoms of lung cancer)
. Current smoker or one who has quit smoking within the last 15 years

If you meet these criteria, contact your physician.  Thanks to recent legislation, Medicare now provides this effective screening program for free for beneficiary patients who meet the criteria.  Most private insurance does as well. You will be required to have a short consultation with your referring doctor so he or she can explain the screening procedure and its risks and benefits. Your physician can then schedule you for an appointment at one of the many accredited screening facilities that are now available. Almost every community has at least one screening program.

The test is quick and painless, and it involves no needle sticks.  You are asked to lie on a CT (CAT Scan) table and short preparatory images are taken.  The exam itself takes one short breath hold (less than 20 seconds), and then you are done.  In a few days you can go over the results with you doctor.

If your test finds no problems, you can schedule yourself for continued yearly exams until you reach age 77 or until it has been more than 15 years since you quit smoking (and your risk of lung cancer decreases).

What if my test finds a problem?  Sometimes the low-dose lung cancer screening test will find a small area that will need a short-term follow-up exam in three or six months.  Most often you will soon return to the yearly cycle of standard follow-up screening  exams.  Occasionally, the exam will find an abnormality that needs a biopsy.  Often the biopsy can be performed without an incision in a short outpatient procedure.

What if a cancer is found?  The good news is that lung cancers found in the screening program are often found early when they can be more easily and successfully treated.  The goal of the screening program is to find more lung cancers early, for example as Stage 1 lung cancer, rather than in later stages.  Stage 1 lung cancers may only need a surgery to treat the cancer.   By finding the cancer early, the patient may be able to avoid chemotherapy and have a better chance of survival.  Early treatment translates to a better quality of life and a longer life.

The most important way to avoid lung cancer is to never start smoking.  However, if you already smoke, quitting now is proven to decrease your chance of dying from smoking.  The risk of dying from smoking-
related causes (heart disease, stroke, cancer, etc.) drops within a few years of quitting smoking, even for long-time smokers.  So if you smoke, the most important thing you can do now is quit smoking.  However, if you are unable to quit or if you quit recently (less than 15 years ago), please make an appointment with your doctor to talk about low-dose CT lung cancer screening.  It may save your life.

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