Lung Cancer Screening FAQ

Prompted by a National Cancer Institute study, the U.S. Preventive Services Task Force has recommended LDCT screening for:

• People between the ages of 55 and 74 who have smoked an average of at least one pack a day for 30 years. This includes people who still smoke or who have quit within the last 15 years.
• People between the ages of 50 and 74 who smoke or used to smoke an average of at least one pack a day for 20 years. They also must have at least one other risk factor for cancer, not including exposure to second-hand smoke.

These risk factors include:

• A family history of lung cancer
• A previous cancer diagnosis
• Emphysema
• Exposure to certain substances, including asbestos, arsenic, beryllium, cadmium, chromium, diesel fumes, nickel, radon, silica and uranium.
• Pulmonary fibrosis

Your healthcare provider or our lung specialists can help determine if you have one of these risk factors.

If you are in one of the high-risk groups for developing lung cancer, but have been previously diagnosed with cancer, your physician can determine whether LDCT lung screening is right for you.

In some cases, LDCT lung screening would not be appropriate, such as when your doctor is already following your cancer with CT studies. Consult your physician.

An eight-year study by the National Cancer Institute of more than 50,000 current and former heavy smokers showed that LDCT scans reduced the relative mortality rate of lung cancer by 20 percent.

If you are at high risk for developing lung cancer, annual LDCT lung screening is recommended for at least three years.

An LDCT lung scan is a safe and simple X-ray exam that takes less than 10 seconds. No medications are required and no needles are used.

There are no dietary restrictions on eating or drinking before or after the exam. However, you must be able to hold your breath for at least six seconds while the scan is being performed.

LDCT scans are so sensitive they can detect abnormalities that require additional testing to verify or rule out cancer. These tests can be other CT scans or imaging techniques. They may also include taking a tissue sample of the tumor with what is called a needle biopsy.

The U.S. Centers for Disease Control has identified at least three risk factors associated with LDCT screening:

• False-positive results — About one-fourth of LDCT patients in the NCI study with suspicious scans turned out not to have cancer.
• Over diagnosis — Sometimes a suspicious mass is determined to be a small, early-stage tumor that would never grow to cause harm.
• Radiation — Additional testing means more radiation exposure, which may cause cancer in otherwise healthy people. That is why LDCT lung screening is recommended only for adults who have no symptoms, yet are at a high risk for developing the disease because of their smoking history, age and family history.
• Findings unrelated to lung cancer — LDCT scans also capture images of areas of your body adjacent to your lungs. In 5 percent to 10 percent of cases, the scan shows a suspicious finding in one of these areas, such as kidneys, adrenal glands, liver or thyroid.

Your radiologist and pulmonologist review the scan immediately after it is performed, then explain the findings to you.

If the scan is clear, the lung specialist may discuss whether you need annual follow-up scans.

If further evaluation, testing or treatment is recommended, our lung specialists discuss these options and a plan of care with you the same day.

If you have a primary care physician, a copy of your results is sent to your physician's office immediately.

If a scan reveals suspicious signs of lung cancer, our interventional pulmonologists thoroughly review the data with you and discuss further diagnostic testing and treatment options. Additional testing may include:

• A higher resolution LDCT scan, a chest magnetic resonance imaging (MRI) scan or a nuclear (PET-CT) scan
• Advanced bronchoscopic sampling of the suspicious nodule
• A transthoracic needle biopsy by our experienced interventional radiology team
• An excisional biopsy (when indicated) by our skilled cardiothoracic surgery team, performed with minimally invasive techniques, including robot-assisted surgery when indicated

We provide you with a comprehensive summary of our findings and recommendations. In cases where the LCDT findings are highly suspicious and urgent intervention is recommended, we are able to prepare you for any next steps immediately. These may include:

• Preoperative medical consultation
• Preoperative EKG (electrocardiogram), when necessary
• Preoperative laboratory testing, if needed

All positive cases are reviewed by our multidisciplinary lung cancer and thoracic oncology teams, with complex cases discussed and reviewed by our multidisciplinary chest tumor board.

Our goal is to provide early and accurate diagnosis of lung cancer and to deliver carefully considered treatment to you, taking into account your individual situation and the best therapy for your particular case.

If you are in a high risk group for developing lung cancer but do not qualify for the LDCT screening program, or are concerned about lung cancer for any reason, our expert team is available for a full consultation and risk assessment.

UCI Health also offers free smoking cessation classes. The weekly classes teach you why you smoke and how to live without tobacco. To register, call 657-282-6357.

Our goal is to diagnose lung cancer at its earliest, most treatable stage in people who are greatest risk for developing the disease. We are striving to make late-stage lung cancer a rarity in Orange County.