Should My Patient Be Screened for Lung Cancer?
Low-dose CT screening (LDCT) is a test used to detect lung cancer before any symptoms appear. LDCT scans can reduce death in those at high risk. Below are key points you may want to use in discussion with your patients who may be at risk for lung cancer or are worried about their risk for lung cancer.
Remember: The best way to prevent lung cancer is to never smoke or stop smoking now. If your patients are still smoking, talk to them about ways you can help them quit. Visit Lung.org/stop-smoking for helpful resources.
Who is a good candidate for lung cancer screening?
If a patient meets the following criteria, they are considered to be at "high risk" for developing lung cancer and screening is recommended:
- 55-80 years of age
- Have a 30 pack-year history of smoking (this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.)
- AND, are a current smoker, or have quit within the last 15 years
There is insufficient evidence at this time that other groups benefit from screening.
A note on insurance coverage:
If a patient is 55-80 years old and has private insurance or 55-77 and has Medicare, and meets the other criteria listed, the initial scan will be covered without cost-sharing.
Be sure to advise your patient to check with their insurance plan for screening coverage and for any additional procedures—there may be other costs associated even if the actual screening is free. Ask the referral facility doing the low-dose CT scan to carefully and clearly explain to your patient all the costs that they may incur and not just the cost of the low-dose CT scan alone. Recommend your patients use the Lung Cancer Screening Insurance Checklist as guidance.
What should I discuss with my patient who may be a candidate for lung cancer screening?
Low-dose CT scan screening is a complicated process and a discussion with any patient should include the activities below. Review these requirements when considering LDCT screening for a patient.
- Take a complete health history
- Determine possible comorbidities and whether they may reduce the benefit of screening
- Discuss the benefits and risks and possible additional procedures that may happen after low-dose CT screening
- Discuss the costs of screening, including financial, personal and time costs
- Advise current smokers to quit smoking, offering to help them with appropriate pharmacologic and behavioral options
Chest X-rays should never be used for lung cancer screening.
Where should I refer a patient for a low-dose CT scan to screen for lung cancer?
Refer them to institutions that are accredited facilities for low-dose CT screening as determined by the American College of Radiology.
- A facility using the latest technology for lung cancer screening
- An expert multidisciplinary team that can provide follow-up for evaluation of nodules. (If the facility does not have that expertise on site, they should be able to make referrals to appropriate institutions.)
Please note, Medicare has a specific protocol in place for physicians and screening institutions. Review these requirements when considering LDCT screening for a patient on Medicare.
What do the results mean?
A "positive" result means that the low-dose CT scan shows something abnormal. This is usually a nodule of a concerning size. You and the team of experts should discuss all possible treatment options with the patient, including clinical trials.
"Negative" means that there were no abnormal findings on this low-dose CT scan. You should discuss when and if they should be tested again.
There may also be an "indeterminate" result and you and the expert team will recommend watchful follow-up and further imaging at a later time.
Whatever the result, if your patient is still smoking, talk to them about ways to help them quit.
Where can I get more information about lung cancer and lung cancer screening?
The American Lung Association has a variety of lung cancer screening resources for patients and healthcare professionals. For more information:
Lung Cancer Insurance ChartDownload
Reviewed and approved by the American Lung Association Scientific and Medical Editorial Review Panel. Last reviewed November 26, 2017.