Friday, November 20, 2015

Shedding light on lung cancer screening


November is Lung Cancer Awareness Month and Jo-Anne Shepard, MD, Director of MGH Thoracic Imaging and Intervention, would like to share important information about the only lung cancer screening test proven to decrease mortality from this devastating illness. 

What is the lung cancer screening test?

Lung cancer can be detected using a low-dose chest CT scan, a procedure that has the potential to identify lung cancer at an early stage when treatment is most beneficial. By using low-dose CT, mortality from lung cancer can be decreased.The U.S. Preventative Services Task Force made lung cancer screening with low-dose CT a public health recommendation in 2013. This independent panel of experts reviews evidence of the effectiveness of clinical preventive services and develops recommendations for those services. The MGH has been offering the low-dose CT scan for many years, but it wasn’t until February 2015 that the procedure was covered by insurance companies for eligible patients.

How does this test work?

There is no preparation necessary for the scan.All a patient has to do is remove any jewelry, lie on a CT scanner table and take a deep breath for a few seconds. The entire process takes about 15 minutes.

Who should get screened?

Eligible patients include current smokers or former smokers who have quit in the past 15 years, are between 55- to 77-years-old and who have a 30 pack-year or greater history of smoking.A pack-year is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years smoked. Patients have to be asymptomatic and be able and willing to tolerate treatment if lung cancer is discovered.

Patients who meet eligibility criteria, or those who want to find out if they are eligible, should speak with their primary care physician or provider. The clinician will discuss smoking cessation and the risks and benefits of this procedure in a shareddecision-making visit, including the need for follow-up testing, the risks of over-diagnosis, false positive rates and total radiation exposure.

Why is lung cancer screening important?

This is the only screening test for lung cancer that has been shown to decrease mortality because of its potential to identify the disease at an early stage. Lung cancer may be cured if it’s discovered early, before symptoms occur.

What is a positive finding?

A positive finding is a nodule in the lung that measures 6 millimeters or greater. Smaller nodules are considered to have a very low likelihood of being a clinically active cancer. It is recommended that patients who have no nodules or very small nodules return in one year for an annual screening scan as long as they meet eligibility criteria.The larger the nodule, the more concerning it is for potential lung cancer.The dedicated thoracic radiologists – who are highly experienced in detecting and managing pulmonary nodules including lung cancers – utilize nationally accepted follow-up recommendations based on the size and level of concern for lung cancer. In the most suspicious cases, a radiologist may recommend specialty consultation, further imaging or potentially a biopsy.Your doctor may contact you to discuss recommendations for next steps if needed.

If you are a current smoker, the best action that you can take to reduce your risk of lung cancer is to stop smoking. It is more effective than any test to reduce your risk. Call the Massachusetts Smokers’ Helpline (free and confidential) at 1-800-QUIT-NOW (800-784-8669).

Read more articles from the 11/20/15 Hotline issue.

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