Q. What is lung cancer CT screening?

A. Lung cancer screening uses low-dose computed tomography (LDCT). More simply defined, it is a CT scan with a low dose of radiation performed to find lung nodules, some of which may be cancer. People who are screened can lower their chances of dying from lung cancer. The U.S. Preventative Services Task Force (USPSTF) published their Final Recommendation Statement on Screening for Lung Cancer on March 9, 2021. The updated recommendations expanded on previous recommendations based on new evidence. USPSTF member Michael J. Barry, M.D stated, “Lung screening can help many more people who are at risk for lung cancer by screening people who are younger and who have smoked fewer cigarettes. We can save more lives and help people remain healthy longer.”

Q. Is lung cancer screening a one-time test?

A. No. Lung cancer screening is not a single test, but rather a process that must be done yearly under the direction of your doctor(s).

Q. Who is eligible for lung cancer screening?

A. Lung cancer screening is not appropriate for everybody. You qualify for a screening if you:

  • are asymptomatic, meaning you have no signs or symptoms of lung cancer including persistent cough, worsening of chronic cough, coughing up blood, constant chest pain, persistent hoarseness or unintentional weight loss of greater than 10 percent of baseline weight. If you have any of these symptoms, then a different type of diagnostic evaluation is required.
  • are between 50 and 80 years of age (although Medicare will only cover the cost for individuals 50-77 years of age).
  • have a history of smoking that includes
    • having smoked within the last 15 years, and
    • having smoked 20 pack-years or more.

Q. What is a pack-year?

A. According to USPSTF, a pack-year is used to describe how many cigarettes you have smoked in your lifetime, with a pack equal to 20 cigarettes. If you have smoked a pack a day for the last 20 years, or two packs a day for the last 10 years, you have a 20 pack-year smoking history.

Q. Will Medicare cover my lung screening if I qualify?

A. As of Feb 15, 2022, Medicare will cover lung screening for high-risk individuals that meet the eligibility criteria mentioned above for individuals 50 –77 years of age.

Q. What are the potential benefits of a lung cancer screening?

A. The major benefit is preventing death from lung cancer. Other potential benefits include:

  • a decrease in lung cancer death by 20% for high-risk individuals.
  • LDCT screening for lung cancer is, at minimum, as effective in preventing lung cancer deaths in high-risk individuals as mammography is in preventing breast cancer deaths and colonoscopy is in preventing colon cancer deaths.
  • if you are concerned about the possibility of having lung cancer, a normal LDCT scan can be reassuring.

Q. What are the potential harms of a lung screening?

A. The potential harms include:

  • Radiation risk:
    • The screening LDCT scan will expose you to a low level of radiation.
    • This is considered a very low risk.
  • Anxiety risk:
    • One in four patients may have a lung nodule or “spot” found. The number of false positive findings or “false alarms” outnumber cancers 25 to one. The vast majority of lung nodules detected on screening (over 96%) are not cancer.
    • One in 10 patients may have an abnormality other than a lung nodule(s) found on the scan that is not causing any symptoms, but may require evaluation.
  • Complication risk:
    • Sometimes a finding leads to the need for additional testing such as a biopsy or surgery that can cause harm in individuals that do not have cancer.
    • The risk for a major complication from invasive procedures is three for every 1,000 individuals undergoing such additional testing.
  • Over-diagnosis risk:
    • There is a possibility that a lung cancer could be diagnosed by screening that would never cause a problem because it is very slow growing.
    • One in 10 lung cancers found by LDCT screening will never cause a problem for the patient.

Q. What happens at the screening?

A. There may be slight variations in the process, but essentially:

  • You will lie flat on the exam table. Pillows may be used for comfort, to help you maintain the correct position and to help you remain still during the exam.
  • You will usually be asked to hold your arms over your head.
  • The table will move through the scanner to the correct starting position for the scans.
  • Then, while you hold your breath for 5 – 10 seconds, the table will move through the machine as the actual CT scan is done.

Q. What is the difference between LDCT scans and a chest X-ray?

A. The 20-percent decrease in lung cancer deaths found in a large national study were through screening with LDCT scans. A separate large national study showed that routine chest X-ray is of no benefit for lung cancer screening.

Q. What is the patient’s commitment to lung cancer screening?

A. Similar to mammography, lung cancer screening is not a one-time test. You should be willing to undergo a yearly screening as long as you continue to meet the eligibility requirements. In addition, you should be willing to undergo surgery to treat early stage lung cancer detected by screening.

Q. How important is smoking cessation?

A. Smoking cessation remains the most effective way to prevent lung cancer. If you are a current smoker, we strongly encourage you to quit smoking. LDCT screening for lung cancer is most effective in decreasing your risk of death from lung cancer when combined with smoking cessation. Please discuss smoking cessation options with your doctor. There are many options available to help you quit including medications, complementary and alternative methods, group support, and counseling. Smoking contributes to other diseases, as well. It may take multiple attempts to quit successfully. Stick with it!

Q. Do I need a prescription for a lung screening?

A. Yes.

Q. How do I obtain a prescription and make an appointment for a lung screening?

A. Speak with your Primary Care Physician or your Pulmonologist and discuss your eligibility for a lung screening. If you qualify, your doctor will give you a prescription and provide next steps. Or, your doctor can forward your prescription to Garnet Health Medical Center’s Centralized Scheduling at 845-333-9009. If you are not established with a physician, you can call Garnet Health Doctors at 845-333-7575 to make an appointment or email an appointment request to appointments@garnethealth.org and a representative will call you to schedule an appointment with a doctor to establish care and determine if you are eligible for a lung cancer screening.

The information in this document is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen. Never disregard professional medical advice or delay in seeking it because of something you have read in this document.