Lung cancer kills more people in the United States than breast, prostate, colorectal and pancreatic cancers combined. However, there’s a new recommendation that can reduce deaths among high-risk patients by as much as 20 percent: annual low-dose computed tomography (CT) scans.
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“These low-dose CT scans have become the standard of care quite recently,” says Peter Mazzone, MD, Director of Cleveland Clinic’s Respiratory Institute Lung Cancer Program.
He says evidence of their benefit came from the National Lung Screening Trial (NLST). The trial showed that using the low-dose scans in people at high risk of developing lung cancer could detect lung cancer in early stages – and save lives.
Early detection is vital
Most people who develop lung cancer don’t feel any symptoms until the cancer has reached an advanced stage. As a result, doctors often diagnose them when treatment can help but rarely cure.
Low-dose CT screening changes the game. It helps doctors detect lung cancer early in its course, when it’s still possible to cure.
In the past, the medical community had considered the low-dose CT scans simply as a form of research, but now, there’s a sea change as yearly low-dose CT scans become the new standard.
“This means that for every five high-risk people who die of lung cancer without getting screened, we can now potentially save one of those people,” Dr. Mazzone says.
The U.S. Preventive Services Task Force also recently recommended the annual low-dose CT screening.
“At this time, it’s the only available form of screening we have for lung cancer. There are no competitive tests,” Dr. Mazzone says.
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Scanning for abnormalities
A low-dose CT scan combines X-ray views from multiple angles to create a two-dimensional image of a person’s lungs. Physicians review these images for small abnormalities, or nodules.
“Most of the scans find a very small spot somewhere on the lung. Sometimes, they find a few spots: two or three or four,” Dr. Mazzone says. “The vast majority of these findings are nothing to worry about.”
Only three or four out of 100 nodules are actually cancerous. If a CT scan shows a person has lung nodules, additional tests can determine if treatment is necessary.
In the past, using CT scans to detect lung cancer was controversial because it exposed people to radiation. But the amount of radiation now being used is five times lower than the amount used in a standard chest scan. This reduced level of radiation led to a consensus among physicians.
“That concern has caused debate,” Dr. Mazzone says. “But at this point, we feel the dose is low enough to provide a very minimal risk.” He notes that doctors do not recommend regular screening for people outside the high-risk categories.
Risk is key factor
Should you get annual low-dose CT screening? Talk to your doctor if you are between age 55 and 74 and if you answer “yes” to any of these questions:
- Do you have a minimum 30-pack-year history of smoking? (A “pack a year” means you’ve smoked one pack of cigarettes a day for a year.)
- Do you currently smoke?
- Have you quit smoking in the last 15 years?
Even for those in the high-risk categories, Medicare and most private insurers do not cover the cost of the test, which Dr. Mazzone hopes will change in the next six months.
“We hope it will be like mammograms, pap smears and colonoscopies — routine and covered,” he says.
Smoking still is greatest risk
While early detection for lung cancer improves with technology, it’s important to note that the best way to reduce your risk of lung cancer is simply not to smoke.
“A 50-year-old who quits smoking reduces his chances of dying from lung cancer by 50 percent, as opposed to our 20 percent from screening,” Dr. Mazzone says.
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