Ask an Expert: Screening tests for lung cancer

Q: "I have smoked in the past; is there any testing that I can have to screen for lung cancer?"

Answer from John R. Handy, Jr., M.D., co-director of Providence Thoracic Oncology Program and director of Providence Thoracic Surgery Program

Some initial studies have shown that newly developing lung cancers may be seen on low-dose spiral CT scans before physical symptoms are present. These CT scans are more sensitive than a chest X-ray for detecting small tumors in the lung. The people who participated in these studies all were at least 55 years old, had smoked at least 20 cigarettes daily for at least 10 years, and had no other signs of cancer.

We need more time to see whether spiral CT scans are good screening tools for detecting lung cancer. There is hope that these scans will help us find lung cancers at an earlier stage, leading to a better chance of survival; however, we do not yet have evidence that this will be true.

CT scans do have two drawbacks:

1.    About 20 percent of people who have spiral CT screening will have nodules detected that require further evaluation, but only 2 percent will have early cancers diagnosed. This means that 90 percent of the people who are found to have an abnormality on screening will need to undergo potentially expensive and uncomfortable testing for something that turns out not to be cancer. 

2.    Patients may have to have nodules followed for up to two years with repeated testing before cancer can be safely ruled out. This period of time can be associated with significant worry and sometimes complications from testing for people who are more likely to have a benign nodule than a cancer.

For those who are interested in having a low-dose spiral CT scan to screen for lung cancer — I recommend talking with your doctor to see if this is a good idea for you. This test is offered by Providence Diagnostic Imaging at many of our locations. This exam is usually not covered by insurance and costs about $350.00.

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