What to Expect from a Lung Cancer Screening

If you are worried about your lung cancer risk, you should consider talking to your doctor about lung cancer screening. Lung cancer screening with low-dose CT scans (LDCT) has been shown to reduce the risk of dying from lung cancer. It catches lung cancer earlier when it is more curable. The steps below will help you know what you can expect from the lung cancer screening process. Each hospital and medical center operates a little differently, so you might encounter these steps in a slightly different order.

1. Talk to your doctor about whether or not you are eligible for lung cancer screening.

   The first step is finding out if you meet the high-risk criteria for screening. The criteria are based on your age, smoking history, and additional risk factors. It is important to remember that your doctor does not necessarily think you have cancer if they suggest a screening test. LDCT screening for lung cancer is similar to other screening tests, like mammograms and colonoscopies.

2. 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.

3. If you are eligible for screening and would like to get the scan, your doctor will write an order for a low-dose CT (LDCT) scan and tell you where to go for your appointment.

   You should call your insurance provider before your appointment to confirm that your scan is covered. Health insurance companies typically cover lung cancer screening for those who meet the high-risk criteria. It is always a good idea to call and confirm your coverage and any out of pocket costs you might have to pay from follow-up produces.

4. The lung cancer screening center will tell you how to prepare for your scan.

   It is easy to prepare for an LDCT scan. Be sure to tell your doctor if you have a respiratory infection as that might affect the results and an LDCT scan should not be completed if you are sick. You will be asked to remove any metal you are wearing, like jewelry, watches, etc. You might be able to stay in your regular clothes or you might be asked to wear a hospital gown.*

5. You will receive your scan.

   The scan itself is painless and quick, less than a minute. You will lie down on the table of the machine. It will slide in and out of the scanner while you lie as still as possible. You may be asked to hold your breath. The technologist who runs the scan will talk you through the whole process.

6. After your scan you can go about your day normally and your doctor will contact you with the results.

   Your doctor will discuss recommendations for next steps. If you have questions about lung cancer diagnosis, treatment and support visit Lung.org/lung-cancer.

• Sources
  1. Hendrick, R. E. (2010, Oct 1). Radiation Doses and Cancer Risks from Breast Imaging Studies. Radiology, Vol. 257, No. 1.
  2. L. Daniel Maxim, R. N. (2014, Sept. 29). Screening tests: a review with examples. Inhalation Toxicology, Pages 811-828 . doi:https://www.tandfonline.com/doi/full/10.3109/08958378.2014.955932