The Importance of Lung Cancer Screening for High-Risk Patients

Low-dose CT scan (LDCT) imaging of the chest is an effective way to screen and detect early lung cancers in high-risk patients ages 50 to 80, with a minimum 20 pack-year history of cigarette smoking and who have been smoke-free for less than 15 years. LDCT makes it possible to diagnose early-stage lung cancer and treat it when curable. Historically, plain chest X-rays proved inadequate, with most lung cancers only detectable and diagnosable at a late stage when cure was not possible.

Low-dose CT imaging of the chest takes about three to four minutes, and its effectiveness makes it important for people at high risk of lung cancer to undergo this screening.

Why Lung Cancer Screening Rates Remain Critically Low

Despite lung cancer screening being available for over a decade, less than 20% of eligible patients undergo screening as part of their primary care. If lung cancer screening were routinely implemented, 12,000 deaths a year could be prevented.

There are several reasons/excuses for the low screening of lung cancer that seem to collectively cause resistance to its adoption.

There is still a lack of awareness among patients about its availability.

Some doctors claim confusion about whether it is covered by insurance, which it is.

Despite clear standards some doctors don’t know who qualifies.

A few doctors, who better need to understand the frequency, fear false positives will lead to unnecessary treatment and disability.

However, screening is the only reliable way to “cure” lung cancer. The important thing is that patients need to know is that screening is available and saves lives. Three numbers are all one needs – 50, 20 and 15.

Over age 50

20 year average of a pack a day

Less than 15 years from last cigarette.

Common Medical Errors That Lead to Missed or Delayed Lung Cancer Diagnosis

There are several ways that medical errors can result in delayed diagnosis of lung cancer and death. The failure to screen LDCT-eligible patients is an all too common an error that leads to missed detection, delayed diagnosis, and a poor outcome, since if screening is not done, it’s often too late when symptoms develop. Annual screening is frequent enough that it will lead to early detection, which typically means that surgery alone is curative. Or, if an LDCT screening test is misread and an early-stage cancer not detected, the same result can follow.

Another unfortunate medical error that leads to delayed lung cancer diagnosis is when a CT scan of the chest is done for other reasons, such as a cardiac calcium exam, and the images show a small lung cancer. In this situation, because the focus of the test is on something else, cancer is overlooked. The cancer might not be reported, or it may be identified as suspicious in the radiologist’s report, but because clinicians are focused on other conditions, this incidental but serious finding is overlooked. By the time symptoms develop, a chance to treat early disease and any chance for cure is gone.

How Patients Can Protect Themselves Through Early Detection

For patients who are at high risk of lung cancer because of a smoking history or exposure to other dusts or irritants, the most important way to protect themselves is to talk about Low Dose CT screening with their primary care physician. The test is quick, has little radiation exposure, and the scan is mostly open and does not cause claustrophobia.

The care pathways for assessing, monitoring, and treating nodules in the lungs are well established. Each year, the chances for false positives decrease and the chances of finding an early curable cancer increase. Doctors need to know and patients need to ask about lung cancer screening. Patients should not hesitate to undergo lung cancer screening if eligible; it can only help them save their lives.