Let’s Talk About Lung Cancer Screening and Prevention
The first step in your fight against lung cancer is avoiding it in the first place. While no one is completely immune to the disease, there are steps you can take to drastically cut your risk.
There’s no blood test or a simple swab of the mouth to learn in an instant if you’re at risk for—or have—lung cancer. But that doesn’t mean you are powerless. In fact, there is a proven screening method for lung cancer and there are things you can do starting today that greatly lower your odds of ever getting the disease. Here at HealthCentral, we’ve talked to the top lung cancer experts and dug through studies and guidelines to bring you the latest lung cancer screening and prevention information. This is what you need to know.
Our Pro Panel
We went to some of the nation’s top experts in lung cancer to bring you the most up-to-date information possible.
Jacob Sands, M.D.
Thoracic Medical Oncologist and Instructor in Medicine
Dana-Farber Cancer Institute and Harvard Medical School
Jorge Gomez, M.D.
Medical Director of the Thoracic Oncology Program and World Trade Center Oncology Clinic
Mount Sinai Hospital
New York, NY
Matthew Schabath, Ph.D.
Epidemiologist and Thoracic Oncologist
H. Lee Moffitt Cancer Center & Research Institute
No. A chest x-ray is not the recommended lung cancer screening method, as it fails to capture up to 23% of all lung cancer cases. Instead, you want a low-dose computed tomography (LDCT) scan, which provides a more in-depth look at your lungs and nearby organs.
Nope. Smoking any type of cigarettes, even these “light” or “ultralight” variations, is dangerous to your health, and smoking is by far the leading cause of all lung cancers. PS: Research shows that smoking unfiltered cigarettes raises your lung cancer risk the most.
No. There’s no research that ties nicotine replacement therapy (including nicotine patches, gum, lozenges, inhalers, and nasal spray) to lung cancer. The nicotine in cigarettes gets you hooked, but it doesn’t give you cancer.
Some evidence suggests that people already at-risk for lung cancer (see: heavy smokers) should not take beta-carotene supplements, as it further increases their risk. But if you don’t fall into that group, beta-carotene in fruits and veggies may actually help stave off lung cancer.
Exactly What Is Lung Cancer, Again?
Every year, more than 228,000 people in the U.S. are diagnosed with lung cancer, making it the second-most common type of cancer in both men and women. It accounts for 13% of all new cancer cases.
Like all cancers, lung cancer begins with a plain-and-simple genetic mutation. Thanks to a DNA hiccup, cells that were once healthy begin to grow abnormally, and their numbers multiply as they replicate. Eventually, these cells clump together to form a mass, or tumor. That tumor begins to destroy otherwise healthy lung tissue, making breathing and delivering oxygen throughout the body difficult.
Why is Lung Cancer Screening Important?
Point blank: Lung cancer screenings save lives. If more people at high risk for the disease got annual lung cancer screenings, more lung cancers would be caught early, reducing mortality.
During a lung cancer screening, your physician uses a low-dose computed tomography (LDCT) scan to test for lung cancer. You don't need to have any symptoms to receive this test; in fact, it's typically used on people who may be at high risk for the disease but have yet to exhibit any signs of it.
This scan combines multiple x-ray images to create a “slice” or cross-section of the body, showing bones, organs, and soft tissues. A single chest x-ray alone is not considered an effective screen for lung cancer and is not recommended. In fact, according to a recent study featured in the British Journal of General Practice, standard x-rays miss up to 23% of lung cancers.
The goal with lung cancer screening is to detect the disease as early as possible, since this is when it’s easiest to prevent the cancer from spreading and causing extensive damage. Lung cancer lacks easy-to-spot red flags, so screening is imperative for catching high-risk cases early. Moreover, high-risk individuals who undergo proper lung cancer screening have a 20% lower chance of dying from the disease than those who did not get screened. Unfortunately, less than 2% of those who qualify for screenings actually get them, possibly because they don’t know the option exists. Equally possible: Fear of scary results and financial costs may deter those who could benefit most from an early diagnosis.
Who Should Get Screened for Lung Cancer?
Today, the U.S. Preventive Services Task Force and the Centers for Medicare and Medicaid Services highly recommend certain at-risk groups get screened for lung cancer annually. To figure out if that includes you, consider the following:
Cigarette count: To be eligible for a lung cancer screening, you have to have smoked (at least) one pack of cigarettes a day for 30 years or two packs a day for 15 years.
Smoking history: You must be a current smoker or have quit smoking within the last 15 years.
Age: You must be between the ages of 55 and 77. That said, some insurance providers may cover screening for people up to age 80 if they are at an elevated risk.
Relative health: Lung cancer screenings are reserved for those who are in relatively good health to prevent complications from unrelated health conditions.
The American Cancer Society also recommends that people who smoke receive counseling to quit in order to be screened.
What Happens During a Lung Cancer Screening?
Lung cancer screenings should only be done at a facility that has the proper LDCT scan equipment and experienced radiologists on hand who are well-trained in lung cancer screening. You can find an accredited LDCT facility near you through the American College of Radiology (go to acraccreditation.org). Under Modality, select “Computed Tomography” and under Designation, pick “Lung Cancer Screening Center.”
Nervous for the scan? That’s totally normal. But know that the LDCT scan itself is painless. There are no pre-scan meds, injections, or fasting requirements—and it takes just about 5 minutes from preparation to see-ya. Here’s how it goes down:
You lie down on a table that slides into the CT scanner, a tube-like machine.
You’ll be asked to keep still and hold your breath for the duration of the scan, which tops out at 20 seconds.
Inside the scanner, special x-rays that use up to 90% less radiation than a conventional chest x-ray will take multiple, cross-sectional images of your body.
A computer then merges these images into a super-detailed picture of your lungs.
Post-scan, a pulmonologist (a doc who specializes in the respiratory system) and a radiologist review your images.
The cost of a diagnostic scan can be as stressful as waiting for the results themselves. But if you qualify for a lung cancer screening, Medicare will cover you. And because lung screenings are also recommended by the U.S. Preventive Services Task Force, many private insurers cover the test.
Why Aren’t More People Screened for Lung Cancer?
The strict criteria for who is—and isn’t—eligible for a lung cancer screening is due, in part, to lack of data on how accurate the machines are for the average person. For instance, while the scans are good at detecting early lung cancers, they are also prone to identifying a slew of suspicious spots that could be lung cancer, but ultimately aren’t. That false positive can snowball into potentially invasive and expensive follow-up testing and even surgery, leading many experts to believe that screening for the general public causes more harm than good.
Still, it’s incredibly frustrating to learn that people with risk factors including a family history of lung cancer or exposure to radon don’t qualify for lung cancer screenings. It’s even more frustrating to know that among women with lung cancer, about 81% would not qualify for screening under the present guidelines, according to a recent study.
The good news? Research is underway to identify never-smokers who may benefit from a lung cancer screening. Additionally, European clinical trials on lung cancer screenings are using more inclusive criteria for people to get screened. It’s foreseeable that the U.S. could adopt broader screening criteria in the near future. In the meantime, if you don’t fall under the current should-be-screened criteria, but are concerned, talk to your doctor about ways to reduce your risk.
How Can I Reduce My Chances of Getting Lung Cancer?
As you likely already suspected, smoking is the number one risk factor for developing lung cancer. According to the National Cancer Institute, smoking tobacco products causes 90% of lung cancer cases in men and 80% in women. So it’s a no-brainer that quitting smoking (or never starting) are the two most powerful things you can do lower your lung cancer risk.
If you currently smoke, it’s not too late. Quitting before lung cancer develops allows your damaged lung tissue to slowly heal and repair itself. As a result, your lung function will begin to improve within just three months of quitting. After 10 years of being tobacco-free, your risk of lung cancer drops as much as 30% to 60%. At the same time, your risk of dying from lung cancer is cut in half.
How Else Can I Prevent Lung Cancer?
There is no foolproof way to guarantee you won’t get lung cancer, but along with quitting (or never starting) smoking, consider these risk reducers:
Test your home for radon. Radon is an odorless, tasteless, colorless radioactive gas that is naturally released from decaying elements in rocks and soil. In small amounts, it does little damage but elevated levels are linked with lung cancer. Radon exposure is the number one cause of lung cancer among non-smokers and is linked to about 26% of lung cancer deaths among never-smokers. Radon detectors are sold at virtually any hardware store.
Limit secondhand smoke exposure. When you sit next to a smoker, you’re taking in the exact same carcinogens (cancer-causing agents) as the smoker, just in smaller amounts. (That’s why secondhand smoke is classified as a carcinogen in and of itself.) Each year, over 7,300 cases of lung cancer are attributed to secondhand smoke. And if you live with a smoker and are regularly exposed to secondhand smoke, your risk of lung cancer increases between 20% and 30%.
Minimize contact with other carcinogens. Asbestos, arsenic, chromium, nickel, beryllium, cadmium, tar, or soot can up your risk of lung cancer, too. If you believe you’re being exposed to these dangerous chemicals at work, reach out to The Occupational Safety and Health Administration (OSHA) to report unsafe work practices at 1-800-321-6742.
Eat fruits and vegetables. Now that we’ve covered what to avoid, how about some advice on what to do more of? To be clear, eating a healthy diet will not 100% shield you from any cancer. However, meals rich in produce may help lower your risk of lung cancer, especially fruits and vegetables rich in carotenoids and vitamin C, according to a recent study. (Of course, if you’re smoking at the same time you’re eating loads of fruits and veggies, you’ve pretty much thwarted any benefits.)
Avoid exercising near traffic. Because particle pollution, like that coming from car and truck exhaust, can cause lung cancer, it’s best not to bike, walk or run along heavily traveled highways.
Of course, you could do all these things and still get lung cancer—it’s nasty that way. But your odds of illness decrease with every one of these tips you follow, including the biggest one of all: Stop smoking. Now.
X-rays and Lung Cancer: British Journal of General Practice. (2019). “Sensitivity of Chest X-ray for Detecting Lung Cancer in People Presenting with Symptoms: A Systematic Review.” uspreventiveservicestaskforce.org/Page/SupportingDoc/lung-cancer-screening/evidence-summary4
Screening Statistics: U.S. Preventive Services Task Force. (2014). “Lung Cancer: Screening.” uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lung-cancer-screening
Lung Cancer and LDCT: Centers for Medicare and Medicaid Services. (2015). “Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (LDCT).” cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274
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