If you meet the high-risk criteria, your doctor will have a shared-decision making discussion with you to help you decide if you want to do lung cancer screening.
During this conversation, you will discuss the benefits and risks of lung cancer screening and what you can expect from the process.
The Benefits and Risks:
The main benefit of lung cancer screening is preventing death from lung cancer. Lung cancer screening finds 80 percent of lung cancer at an early stage when it is more curable. Without screening, 70 percent of lung cancers are found at a later stage when there is little chance for a cure.
Like all screening tests, lung cancer screening does have risks. There is a low radiation exposure risk. The amount is about the same as what an average American gets in six months of natural background radiation by living on planet Earth. This is a little bit higher than the amount of radiation women are exposed to through a mammogram.1
Whenever physicians are able to take a detailed look at an organ, like the lungs, they might find things that look like cancer but are not (called a false positive). Or they might find nodules that are very slow-growing cancers that would never cause you harm. But because there is no way to know if the cancer is slow growing, this might mean you will get follow-up tests or treatment that you wouldn’t have if you hadn’t had the scan (called overdiagnosis).
False positives are not uncommon in screening tests.2 or lung cancer screening, about 12-14 percent of the initial screening scans will have a false positive. This is similar to a mammogram. This drops to about 6 in 100 (6 percent) for continued annual screening scans because the new scan can be compared to the first scan for changes. The good news is that both the rate of false positives and overdiagnosis is decreasing in lung cancer screening due to new tools that help physicians better decide who should go on for more testing and who should not. As the science of lung cancer screening advances and the management of screening improves, we expect to see further declines in these rates.
The scan also sees other parts of the body, not only the lungs. Sometimes this can show things that may be medically concerning and may need follow-up testing or treatment. These are called incidental findings. About 6 out of 100 (6 percent) initial screening scans show an incidental finding. Similar to false positives, this drops to about 2 in 100 (2 percent) for continued annual screening scans.
Your doctor will talk with you about the likelihood of false positives, overdiagnosis and incidental findings and explain what you can expect after the scan.
The Follow-up:
Your doctor will also discuss what might happen after the scan. If a screening test result is abnormal you might need to have more tests to find out if you have cancer. Even if there are no nodules that require follow-up, similar to a mammogram, you will still be asked to come back yearly for a scan. If there is a small nodule, your doctor might recommend you come back for another scan to see if it has grown. If there is a nodule that looks suspicious, your doctor might recommend more testing like a PET scan or a biopsy to find out if it is cancer. If you do have cancer, your doctor will likely recommend treatment which could include surgery, chemotherapy, radiation, immunotherapy or targeted therapies.
An important part of this shared-decision making conversation is helping patients quit smoking. If you currently smoke, your doctor will also counsel you on the importance of quitting smoking and provide you with resources to help you quit.