Lung Cancer CT Screening
This information was reviewed and approved by Debra S. Dyer, MD, FACR (9/1/2021).
Can Lung Cancer Be Prevented?
The best thing you can do to prevent lung cancer is to stop smoking. National Jewish Health can help you stop smoking by working with the QuitLine at 1.800.QUIT.NOW. Lung cancer can also be prevented by avoiding the environmental exposures mentioned in causes of lung cancer. In spite of that, some individuals still will develop lung cancer. In that case, our best option is to find the cancer early in order to cure it. Early lung cancer detection is done by lung cancer screening.
Lung Cancer CT Screening Program
Lung cancer screening can identify a lung cancer early when it is small and curable. Lung cancer screening is done by a CT scan. The vast majority of people undergoing a screening CT will not have cancer. The CT may show an abnormality that subsequently proves to be benign, as benign nodules are common. This is a false-positive test that can lead to anxiety and other diagnostic procedures that may not be needed.
Screening looks for a disease before a person has symptoms. Screening is recommended if a person is at high risk for disease, but has not developed symptoms of the disease.
People at high risk to develop lung cancer are defined by their age and smoking history. The results of a large study in the US, the National Lung Screening Trial (NLST), showed that screening high-risk individuals with yearly low-dose CT scans can detect lung cancer early and significantly improve lung cancer survival. The ability to find lung cancer early, in high-risk patients, by CT scanning has also been proven in a large study performed in Europe, the NELSON study. You can read a paper describing the study on the Radiology website.
Lung cancer screening involves an evaluation to see if you fall in the high-risk category and will benefit from being screened; smoking cessation if you are smoking; and a chest CT scan. The Lung Cancer Screening Program at National Jewish Health focuses on early detection of lung cancer. Because a screening CT identifies suspicious lesions in high-risk individuals before there are any symptoms, lung cancer can be detected earlier when it is more easily treated. National Jewish Health is recognized as a leading Lung Cancer Screening Program by respected lung cancer organizations and the State of Colorado, including:
Screening Center of Excellence by the Lung Cancer Alliance
Designated Lung Cancer Screening Center by the American College of Radiology
Certified Healing Arts Screening Program by the State of Colorado
Our radiologists have special expertise in chest and lung imaging, including lung cancer screening.
Who should consider participating in the Lung Cancer CT Screening Program?
If you have all three of these risks, you fall into the category of high risk for developing lung cancer and experts recommend lung cancer screening:
You are 50 to 80 years old.
You are a current or former smoker, with at least 20 pack-years of smoking.
Pack-years are determined by the number of cigarette packs smoked per day multiplied by the number of years you smoked.
You are a former smoker, who quit within the past 15 years.
Transcript
Alyssa Paschke: Hello and welcome to our Live Q and A about lung cancer screening. My name is Alyssa Paschke, and today I'm joined by Dr. Debra Dyer. She's the chair of our radiology department here at National Jewish Health, and, since November is coming up ... November is Lung Cancer Awareness Month, so we wanted to discuss the lung cancer screening and if it might be right for you.
Alyssa Paschke: So the lung cancer screening CT is a tool that we use in order to find lung nodules or lung cancer, and early detection is the best way to ensure success of treatment. If caught early, lung cancer can be cured.
Alyssa Paschke: So I wanted to invite anybody out there watching to answer ... or ask any questions, and we'll answer them live.
Alyssa Paschke: So, to start, Dr. Dyer, thanks so much for joining us, and Iwanted to tell everybody a little bit about what the lung cancer screening CT is.
Dr. Debra Dyer: Yes. So the lung cancer screening CT is a new tool that we have as a result of evidence that ... in the literature that shows that lung cancer screening CT can reduce the mortality of lung cancer by 20% in patients ...
Alyssa Paschke: Wow.
Dr. Debra Dyer: ... who are high-risk and eligible for the screening CT. So the really good news is we had the results of a big national study in 2011, and, as a result of that, the US Preventative Services Task Force gave the go-ahead that lung cancer should be performed in high-risk groups.
Dr. Debra Dyer: So patients with commercial insurance that meet eligibility requirements were then able to get lung cancer screening as a preventative service at no cost on an annual basis, and that was at the end of 2013. In 2015, Medicare came on board. Medicare said the same thing - "If you meet the eligibility criteria, we'll cover it as a preventative service."
Dr. Debra Dyer: So we're very excited that we have this great tool to be able to offer, that really can reduce mortality in patients who are high-risk. Then the really exciting thing that's happened, just in the past month, is there's been a pretty good-sized European trial called the NELSON Trial, and it showed even better results, that lung cancer mortality could be reduced by 26%.
Alyssa Paschke: Wow.
Dr. Debra Dyer: So we're thrilled, and we know that we have an important tool in being able to help patients.
Alyssa Paschke: Great. So that's great information. So, for anybody out there thinking, "Well, how would I possibly qualify for that low-cost or free screening, and what are the kind of requirements to qualify?"
Dr. Debra Dyer: So the requirements to get the study as a preventative service, then at no cost and no cost-sharing, even - so no copay, no cost-sharing or application to deductible - patients have to be at least age 55, and they have to have smoked 30 pack years. A pack year is one pack a day for 30 years. So if you smoke two packs a day for 15 years, that's the same as 30 pack years.
Alyssa Paschke: Oh, okay.
Dr. Debra Dyer: All right? Then patients either have to be current smokers or quit within the past 15 years, and then, of course, they do have to be willing and able to undergo therapy. Now, it doesn't have to be surgery, because we can also offer radiation therapy, but they have to be healthy enough to be able to get curative procedures.
Alyssa Paschke: Okay. That totally makes sense. So I know you mentioned smoking as a risk factor. We had a question come in from the audience prior to going live from Carrie Ann in Denver. She wanted to know if it's a good idea to get screened if you've been previously exposed to radon.
Dr. Debra Dyer: That's a really good question, and, as of right now, radon by itself is not considered a high enough risk factor for us to be able to recommend lung cancer screening. Now, if a patient is exposed to radon and has additional risk factors, then they would be eligible.
Dr. Debra Dyer: At our facility, we also follow another set of criteria to allow patients to self-pay for lung cancer screening CT if they have something like radon exposure, asbestos exposure, and 20 pack years of smoking and age 55. So there is an option for those folks. It's a self-pay. At our institution, it's $250 for the whole package, and that's a pretty good deal, I think, to get the scan and the interpretation and also meet with a nurse practitioner and talk about the scan, the scan results, and so forth.
Alyssa Paschke: Okay.
Dr. Debra Dyer: So, for the patients that are concerned about radon exposure, I totally understand. It is a risk. We know that. Unfortunately, we don't have evidence yet to have it covered by insurance or Medicare.
Alyssa Paschke: Okay. Well, that's good to know, and I just want to turn it over to see if any questions have come in from the audience.
Speaker 3: Yeah. Someone in our audience was wondering if having a sibling that had lung cancer was going to increase their chance, someone in their early 40s.
Dr. Debra Dyer: That is another one of those risk factors that applies to ... If you have a family history and 20 pack years of smoking and age 50, then we would scan you on a self-pay basis. It doesn't, by itself, qualify you for the preventative service without the smoking history. But it is a significant risk factor.
Alyssa Paschke: That's definitely good to know. Any other questions that have come in?
Speaker 3: Not at this time.
Alyssa Paschke: Okay. Well, I'll keep going. So, during the CT scan process, are there any concerns with exposure to radiation while the scan's going on?
Dr. Debra Dyer: So that is a very good question. We have certainly taken radiation exposure in medical imaging seriously, and, over time, certainly since CT first started about 30 to 40 years ago, the technology's gotten better and better, and we're able to scan patients at lower and lower radiation doses.
Dr. Debra Dyer: In addition to that, at our institution here, we have extra tools on our scanner so that we can scan a patient at what we call a low-dose protocol. Then we have some additional tools to reduce the dose even further. So we can do these scans at about a seventh of the dose of a usual chest CT.
Alyssa Paschke: Okay.
Dr. Debra Dyer: That is way less, actually, than the background radiation living in Denver.
Alyssa Paschke: Oh, wow. I didn't know that.
Dr. Debra Dyer: So, anyway, it's not thought to be a risk, a serious risk. I mean, it is something that we talk to patients about, that they do need to understand that there is radiation exposure. But we do everything in our power to decrease the dose.
Alyssa Paschke: That makes sense. So the scan is well worth the possible radiation exposure.
Dr. Debra Dyer: Yep.
Alyssa Paschke: Great. Well, I think next we wanted to talk a little bit more about the scan itself and if lung nodules are found. I know you have some great examples of scans here. So just wanted to show the audience what you can tell us about these scans and what you look for in the scan after it's completed.
Dr. Debra Dyer: Sure. So we do follow a national protocol for reading our lung cancer screening CTs. It's something called Lung-RADS that the American College of Radiology has developed and endorsed, and radiologists across the country use this Lung-RADS protocol.
Dr. Debra Dyer: If we find a nodule, it really depends on what the nodule looks like. Sometimes the nodule is sort of simple-looking and has smooth margins and may just, by its size, be in the realm that we would just recommend a followup CT in three months or six months.
Dr. Debra Dyer: However, if it's a nodule and it looks something like this, this is a patient who smoked, and this area here is a nodule that looks pretty scary. It has these irregular margins, and certainly the nodule should not be there to begin with, but the other thing that's kind of scary here is that these margins are so irregular.
Dr. Debra Dyer: So in this case, we read this scan as highly suspicious, and that means the patient is going to go on and get some additional imaging or workup. So one of the first things we would do is go on and have the patient get what we call a PET-CT, and a PET-CT actually combines technologies. So it's a nuclear medicine study along with a CT scan, and it can tell us the metabolic activity of the nodule.
Dr. Debra Dyer: That's important, because a highly active nodule, a nodule that has a lot of metabolic activity is, for the most part, either going to be cancer or infection.
Alyssa Paschke: Okay.
Dr. Debra Dyer: So, in this case, the patient was not sick. So we then zeroed in on this as this is highly worrisome, then, for lung cancer. So here's just another view of what that looks like when you look front-on at the patient. So you can see there's this metabolically active nodule here in the upper right lung.
Dr. Debra Dyer: So this patient then went on to have a CT-guided lung biopsy. So we have basically two ways to biopsy lesions. We can go from the outside in. So we can have a nodule ... I mean, a needle that is directed through the skin. If you notice, this patient is now flipped, and they're lying on their stomach, but, because this nodule's towards the back, we put the needle in towards the back. We then sample the tissue.
Dr. Debra Dyer: The other way that we can get tissue is to go from the inside out. So we do, here at National Jewish, certainly, a number of broncoscopies, where we can get tissue and sample nodules then from the inside. So if this nodule was closer in, we would've done a broncoscopy.
Dr. Debra Dyer: But the important thing here is that we got tissue, and we found this patient had a lung cancer. But the really important, good thing is that there was no evidence of any metastatic disease. This is a stage one lung cancer, and this is why we found that decrease in mortality. Traditionally, lung cancers have, unfortunately, been found at a late stage, and there's not as much to offer them. If you can find a cancer at this stage, then all you have to do is remove it.
Dr. Debra Dyer: In fact, in her situation, she had surgery. She had the nodule wedged out, just cut out from the lung. This is her six years out from her surgery. So we see a couple scars here, but no recurrence of lung cancer. In fact, that's the whole idea here, is that you can treat them early with just surgery, no need for chemotherapy, no need for radiation, if you can do the curative process with surgery.
Dr. Debra Dyer: I did mention some patients may not be good surgical candidates, but we can use radiation to treat the nodule and still get good results. But the key is you want to catch it early, which we did here.
Alyssa Paschke: Awesome. Well, that's a really great example of why the screening is so important. So what I wanted to do was pass it back to the audience and see if we've had any other questions come in. So go ahead.
Speaker 3: Yeah. Yeah, someone wanted to know if they have chronic and recurring lung infections, does that increase your chances of developing lung cancer?
Dr. Debra Dyer: Well, I guess it would kind of ... We'd need to know why they have the recurring lung infections. If, in fact, they are a smoker and they have chronic bronchitis, then they may have something called COPD. COPD is a risk factor for lung cancer, and they certainly should take our test and see if they're eligible. We have a quiz we're going to tell you about in a second, and see if they might be eligible for lung cancer screening.
Dr. Debra Dyer: The infection of chronic respiratory infections aren't really, by themselves, a risk, but certainly whatever the underlying issue in the lungs, that may set them up for being at an increased risk for lung cancer.
Alyssa Paschke: All right. So, since you mentioned the quiz, we definitely want to introduce that to everybody who's watching because of the different risk factors that we talked about and the different ways you could qualify for a free screening. So do you want to talk a little bit about the quiz?
Dr. Debra Dyer: Sure. So we're very excited. Working with our partners at St. Joseph Hospital, we have developed a tool that patients can take that determines whether they may be at risk for lung cancer.
Dr. Debra Dyer: It starts off with asking their age. So let's just assume that this patient is age 55 or older. Then it's going to ask how many cigarettes have you ... how many years have you smoked cigarettes. So we want to enter 30. Then it's going to say, "How many packs per day?" So we're going to say a pack per day.
Dr. Debra Dyer: Then that takes us ... Oh, why does it ... Oh, it didn't bring this question up yet. "Have you smoked in the last 15 years?" We're going to say yes. Oh, I think I didn't get that question before. Okay. "How many years have you smoked?"
Dr. Debra Dyer: Okay. Because, then, I am ... Because of the answers that I provided, this tells me that I have met the criteria for lung cancer screening to be covered at no cost by my insurance or Medicare. If you wanted to request a lung cancer screening exam through us, you can enter your name here and contact information. We have a dedicated patient navigator. He works for both National Jewish and St. Joe's to navigate patients into our lung cancer screening program.
Alyssa Paschke: Great. Well, thank you for showing us that. I think it's a really useful resource that people can actually visit now.
Alyssa Paschke: So what I wanted to do to wrap up was to thank you again for speaking with us. I think this is a very important topic, and just getting the awareness that those free screenings are available is super important. So thanks again, and, like we said, the early detection is your best bet for success with treatment and to live a longer, healthy life. So we encourage the early detection and early screenings if you qualify.
Alyssa Paschke: If you wrote in and we didn't get to your question, we will be sure to follow up with you in the comments. If you happen to have a question after we're done here, feel free to comment on our video, and we will follow up there as well.
Alyssa Paschke: You can take the lung cancer screening quiz right now by visiting workingtogether.org/lungcancerquiz. Again, that's workingtogether.org/lungcancerquiz.
Alyssa Paschke: If you'd like to receive any additional information, news from National Jewish Health, you can visit our website at njhealth.org. Thanks for watching.
When the CT scan finds a lung nodule, the nodule needs to be examined and watched closely, because it may or may not be a cancer, or could become cancerous in the future and need to be treated. The Lung Cancer Screening Program at National Jewish Health helps patients at risk for lung cancer monitor their screening results along with their primary care doctor, and start treatment at the earliest possible time.
Many nationally respected organizations recommend lung cancer screening CT scans for high-risk individuals.
American Cancer Society
American College of Chest Physicians
American Society of Clinical Oncology
National Comprehensive Cancer Network
American Thoracic Society
American Lung Association
American Association of Thoracic Surgery
United States Preventive Services Task Force
American Medical Association
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