By Walter Silbert, MD
Lung cancer causes more cancer-related deaths each year in Tompkins and surrounding counties than any other type of cancer. The most important risk factor for the disease is smoking, which results in approximately 85 percent of all U.S. lung cancer cases. One of the reasons it remains so lethal is that lung cancer is not typically discovered until a patient develops symptoms at which point successful treatment is less likely. In fact Lung cancer diagnosed in its late stages has a poor prognosis and 90 percent will die from the disease. Fortunately, when lung cancer is detected early in the disease process — before the onset of symptoms — it is more responsive to treatment and patients often have a longer life expectancy.
An early detection lung cancer screening offered at Cayuga Medical Center and Schuyler Hospital has proven very successful in identifying early-stage cancers when treatment can be most effective. The lung cancer screening uses low-dose computed tomography (LDCT). It is the only screening test for lung cancer that is recommended by the U.S. Preventive Services Task Force, a panel of national experts in prevention and evidence-based medicine. The test uses low doses of X-ray radiation to make detailed pictures of the lungs. It is painless, noninvasive, and similar to the use of mammography in annual breast cancer screenings.
Who is at risk?
Smoking is by far the leading risk factor for lung cancer. About 80% of lung cancer deaths are thought to result from smoking. The risk for lung cancer among smokers is many times higher than among non-smokers. The longer you smoke and the more packs a day you smoke, the greater your risk. It is important to understand that screening cannot prevent most lung cancer–related deaths, and smoking cessation remains essential.
Who should be screened?
An annual lung cancer screening with LDCT is recommended for people who have a history of heavy smoking, currently smoke or have quit within the past 15 years, and are 55 to 80 years old.
Heavy smoking means a smoking history of 30 pack years or more. A pack year is smoking an average of one pack of cigarettes per day for one year. For example, a person could have a 30 pack-year history by smoking one pack a day for 30 years or two packs a day for 15 years.
The incidence of lung cancer is relatively low in those younger than 50 years but increases with age, especially after age 60 years. In current and former smokers, age-specific incidence rates increase with age and cumulative exposure to tobacco smoke.
What are the test’s benefits?
Annual LDCT screenings can prevent a substantial number of lung cancer–related deaths for those at high-risk for the disease. The magnitude of the test’s benefit depends on a person’s risk for lung cancer, with those at highest risk most likely to benefit from testing. Annual LDCT screening helps to detect lung cancer at an earlier stage prior to onset of symptoms and when treated at its early stages lung cancer has a better prognosis.
What are the test’s risks?
Most medical tests involve a risk. That is why LDCT screening is recommended only for adults who have no symptoms of lung cancer, but who are at high risk for developing the disease because of their smoking history and age. A significant risk associated with LDCT screening is a false-positive finding that occurs when the screening’s test results indicate there may be cancer when there is not. False-positive results increase patient anxiety and may lead to further testing that may prove to be unnecessary.
When should screening stop?
Testing stops after age 80, when the patient has not smoked for 15 years and thus is no longer at high risk, or when other health problem make a patient unwilling or unable to undergo treatment for lung cancer if detected at LDCT screening.
What happens after an LDCT lung screening?
Following a LDCT test, a radiologist reviews the images and rates the likelihood of the patient developing lung cancer. The results are forwarded to the patient’s primary-care provider who shares the results with the patient. In about 90 percent of the tests, the results find no cancer, or a low likelihood of the patient developing lung cancer, and a re-test is recommended in 12 months. When test results show a patient has a higher risk for developing lung cancer, LDCT tests may be repeated sooner and other diagnostic tests may be recommended.
Is the cost of lung screening covered by insurance?
Medicare Part B covers a lung cancer LDCT screening once per year when a person meets several conditions related to their smoking history. A patient needs a physician’s order to be eligible for the Medicare coverage. Private health insurance policies vary in their coverage, so it is best to verify with the insurance carrier what the approved criteria are for annual lung screening using LDCT.
Where are LDCT screenings done?
Screenings can be scheduled at Cayuga Health System locations at Cayuga Medical Center, (607) 274-4046, and at Schuyler Hospital, (607) 535-8613.
Dr. Silbert is board certified in diagnostic radiology and is on the medical staff of Cayuga Medical Center, where he and his diagnostic radiology colleagues, supervise and interpret LDCT lung cancer screening exams. The radiologists provide a full spectrum of diagnostic medical imaging exams and perform interventional procedures that are accredited by the American College of Radiology Committee on Quality and Safety.