Lung cancer screening
Lung cancer screening is done with CT scans. In the past chest x-rays and sputum (phlegm) samples were tried, but were not found to be effective. The CT scan is quick (less than 5 min). Cost can vary, but most people who qualify for lung cancer screening will have the scan as well as a consultation to discuss lung cancer screening covered under insurance.
The National Lung Screening Trial was published in 2011 and showed a 20% reduction in lung cancer deaths if lung cancer screening using low-dose CT scans was implemented for high risk patients.
If you screen 320 patients for lung cancer, that will save 1 life. Although this seems like a lot of people need to be screened to save one life, you need to screen 746 for breast cancer and 935 for prostate cancer which are screenings that have been well-established and adopted in the US.
However, lung cancer screening has been poorly adopted in the US (and around the world) with most people (including physicians) not being aware that screening is recommended and the requirements. Only 5.8% of eligible people are screened for lung cancer in the US. The state with the best adoption of lung cancer screening is Massachusetts at 16.3% and the lowest adoption rate is 1%. Screening saves lives by detecting lung cancer earlier, so see the eligibility criteria below and if you qualify, speak to your doctor about getting a low dose CT scan for lung cancer screening.
You qualify for lung cancer screening if you:
- Are between 50-80 years old
- Have at least 20 pack-year smoking history
(meaning you smoked 1 pack per day for 20 years, 2 packs per day for 10 years or half a pack per day for 40 years, etc.) - Are either still smoking or have quit, but it has been less than 15 years since you quit smoking
Who is at risk?
EVERYONE is at risk for lung cancer. All races, genders, LGBTQIA+. Lung cancer does not discriminate, and you do not need to have ever smoked to get it!
Specific risks include:
•Radon exposure (this is in the soil in some places)
•Workplace chemical exposure (Arsenic, Asbestos, Nickel)
•Air Pollution
•Genetics (having someone in your family who has had lung cancer or having certain genetic conditions)
•Radiation Therapy
•Lung Disease (COPD, Interstitial Lung Disease)
•Tobacco, Inhaled Marijuana or Vaping Use
•Exposure to Secondhand Smoke
•Ageing
Most patients do not have any symptoms until lung cancer is at an advanced stage
When lung cancer symptoms do occur, they vary depending on the type of lung cancer as well as the location and size of the tumor.
Most lung cancer symptoms are vague and similar to those of other common illnesses which makes it difficult to suspect and make a diagnosis.
Everybody, Regardless of Race, Gender, Sexual Orientation etc. Deserves Equal Care
Race:
- Black men are about 12% more likely to develop lung cancer than white men.
- Five-year survival rate is also lower in Black people.
- Black people tend to develop lung cancer with less smoking history then other races; in other words, Black people tend to be more sensitive to the effects of tobacco and smoking than other races.
Black Americans are also under-represented in clinical trials. Since we know that treatments work differently in people, it is important to understand how ALL people respond to them so representation from ALL people is vitally important. The percentages of participation in clinical trials are 6% for Black Americans and 83% for Caucasians. This needs to change.
Asian women in the US who have never smoked are twice as likely to develop lung cancer than female non-smokers of other ethnicities.
Gender:
Race is not the only disparity, women who never smoked are more than twice as likely to get lung cancer as men who never smoked. These people do not yet qualify for lung cancer screening.
Lung cancer now is diagnosed in more women than men every year in the United States. It has caused more deaths in women than breast cancer annually since 1986.
HIV, LGBTQ+ and others:
HIV-infected patients have an estimated 52% higher lung cancer risk when compared with non-infected individuals. These patients also present at late stage, with only 15% presenting at an early stage, so average survival is also worse at 3.5 compared to 6.3 months.
Rural populations have less access to screening, treatment and follow-up care. Access and increased insurance coverage needs to improve.