The effectiveness of early detection is one of the universal truths in medicine. It is so effective that the U.S. Preventative Task Force recommends that patients get screened for colon cancer, breast cancer, skin cancer, prostate cancer and lung cancer. Even when there are no symptoms, doctors need to recommend screenings based on the patient’s unique medical history, a check for diseases that commonly appear as the human body ages, or perhaps the patient had exposure to something through work or other activities.
Lung cancer screenings, however, seem to get overlooked as a precautionary measure or diagnostic tool. Despite being the second most common type of cancer – one that causes more than 135,000 deaths and more than 225,000 cases annually in the U.S. – one study shows the lung cancer screening rate as 14% among eligible smokers.
Shame seems to be an issue
Part of the problem it seems is that doctors are not talking about it. Cigarette smoking is a well-documented and pernicious addiction, but it often gets treated differently than addiction to alcohol, painkillers, gambling, or other harmful behaviors.
Rather than treat the illness with testing, physicians are likely to start the conversation with a simple warning: “you need to quit smoking.” Smokers are ashamed that they cannot kick the habit, but it is rarely as simple as just “stopping.” Rather than get shamed by their doctor, they need to get regular physicals and the doctor needs to inquire about their smoking in a non-judgmental manner so that the patient feels comfortable revealing the full extent of their smoking history. Doctors must create an environment that encourages the patient to tell them everything and not fear being shamed for a habit that mass marketing likely got them started on years before.
Doctors are often to blame
Rather than simply warning smokers to stop, medical professionals need to stop the lecture and try to determine if there is an undiagnosed medical condition. They can set the tone by opening up a working dialogue with the smoking patient, explaining that early detection and treatment can help avoid more dire outcomes. Rather than use the excuse that a negative test may embolden the smoker to continue, it should be used to motivate the smoker to quit while they are ahead or get the help they need to do it.
One thing is clear
The U.S. Preventative Task Force recommends that long-term smokers (20-pack year smokers—a pack a day for 20 years, two packs for ten years, etc.) over 50 years old, or one who quit, but whose last cigarette was in the last 15 years should be screened annually for lung cancer using a low-dose CT scan. It estimates that testing these high-risk patients could save 24,000 lives per year. Lung cancers detected early, when the cancer can be detected, have an 85% cure rate, as opposed to later stage detection, where cure is often impossible.
November is National Lung Cancer Awareness Month. Now is a good time for doctors and patients to have open conversations about smoking and low-dose CT—there is little to lose and many lives to save in doing so.