The How, When and Why of Lung Cancer Screening

Lung cancer is the leading cause of cancer death worldwide, taking the lives of nearly the same number of people who will die from colon, breast and prostate cancer combined. While you may fear a diagnosis of lung cancer, a simple exam offers the best opportunity to find cancer early in high-risk individuals - and can give you the best chance for a positive outcome.

Why should I screen for lung cancer?

A key to surviving lung cancer is catching it in its earliest stages when it is most treatable, said Benjamin Newton, MD, a medical oncologist with Smilow Cancer Hospital and assistant professor of Medicine (Medical Oncology) at Yale Cancer Center who treats patients at Smilow Cancer Hospital in Waterford and Westerly. “The survival rate for lung cancer is based on the stage of the cancer at the time of the diagnosis. A higher stage means that the cancer has spread more. The earlier that a lung cancer is diagnosed, the more likely it is that treatments can eliminate it,” he said.

Early-stage lung cancers are much more amenable to better long-term control through surgery, radiation treatment and medical therapy," Dr. Newton said. “This is why screening is so important. In addition, early-stage lung cancer almost never causes symptoms, so the main way to diagnose it is with a scan.”

Who should be screened for lung cancer? 

Smoking, or exposure to tobacco products in any form, is the major risk factor for lung cancer. Statistics show that cigarette smoking is linked to approximately 80 - 90 percent of lung cancer deaths. Using other tobacco products such as cigars also increases the risk of lung cancer, as does secondhand smoke.

There is concern that vaping and e-cigarette use may also increase lung cancer risk. “We do not yet have the kind of long-term research that would confirm the health implications of using these products, but there is clear reason to think that vaping and e-cigarette use could cause lung cancer too,” Dr. Newton said.

The Early Detection Lung Screening Program at Lawrence + Memorial Hospital uses low-dose computed tomography (CT) scans to detect lung cancer in smokers and former smokers who exhibit no symptoms of the disease.

According to Louis Mazzarelli MD, a radiologist at L+M Hospital and director of the screening program, anyone between the ages of 50 and 80 who currently smokes and has smoked an average of one pack per day for at least 20 years should be screened for lung cancer. People who fit the “20 pack year” smoking history profile but have quit within the past 15 years should also be screened.

“Pack years” are calculated by multiplying the number of packs smoked a day by the number of years they’ve been smoking. A person who smoked two packs a day for 10 years, for example, would have 20 pack-years.

“Quitting smoking is the most effective strategy to prevent the development of lung cancer,” Dr. Mazarelli said. “But even after you stop smoking, the risk for lung cancer stays elevated up to 15 to 20 years later. That’s why lung cancer screening is so important. If you wait until you have symptoms, the cancer is much more likely to have already spread.”

How is lung cancer screening done? 

Low-dose CT scans require no preparation – there are no medications, no needles, and you can eat and drink before and after the scan. The entire exam takes about a minute.

“In terms of screening, this is as easy as it gets,” Dr. Mazzarelli said. “It’s not exaggerating to say that 60 seconds can save your life.”

Are you concerned about exposure to radiation during the scan? According to Dr. Mazzarelli, low-dose CT imaging provides nearly 80 percent less radiation exposure than a standard CT. “The radiation dose from a low-dose CT is similar to the amount received by a patient having mammography,” he said.

Another benefit: CT scans can highlight health concerns other than lung cancer, including heart abnormalities, aneurysms and other cancers.

Screening for lung cancer with a yearly CT scan is covered by many insurance plans, including Medicare and Medicaid, for eligible patients, he said.

Get help to quit smoking 

The best way to prevent lung cancer? Don’t smoke. The next best? Quit smoking if you’ve started. “Lungs can actually get healthier over time, so quitting decreases your chances of developing cancer,” said Dr. Mazzarelli. 

L+M’s Lung Cancer Screening program includes one-on-one counseling and strategies for quitting smoking along with the annual CT imaging. The free program is available at Smilow Cancer Hospital locations in Waterford and Westerly. For information about enrolling, patients can contact program coordinator Karen Geary at 860-271-4273 or at [email protected].

“Patients feel like it’s their fault if they get cancer because they smoked. But quitting smoking is a process. We are here to offer hope and help people become tobacco-free,” Geary said

I have lung cancer. What happens next?  

Dr. Newton points to the collective experience of the national and international experts at Smilow Cancer Hospital  and Yale Cancer Center, where the medical teams can offer patients with advanced lung cancer a wider array of options that may include targeted therapy, immune therapy or clinical trials.

How can I be screened for lung cancer? 

Talk to your primary care provider if you think you met the screening criteria and request a referral to the program at L+M. 

Lung cancer screening offers the best opportunity to find cancer early in high-risk individuals and gives these patients the best chance to have a positive outcome. According to Dr. Mazzarelli, that’s what matters in the end.

“When we talk about survival rates and a certain percentage of lung cancer patients being alive in 5 or 10 years, these are lives we are talking about. Those are years filled with weddings and vacations and grandkids being born,” he said. “When we screen and diagnose lung cancer early enough, our patients get the gift of time.   

Symptoms of lung cancer 

Early symptoms may be mild, or they may be dismissed as common respiratory issues. This can lead to delays in being diagnosed. The most common symptoms of lung cancer include:

• Cough that does not go away
• Chest pain
• Shortness of breath
• Coughing up blood
• Fatigue
• Weight loss with no known cause
• Lung infections that keep coming back

If you have any of these symptoms, schedule an appointment with your primary care provider as soon as possible.

If you don’t have a primary care provider, call 833-346-3637 for information on physician specialties, office hours and locations as well as insurance plans accepted.