Lung Cancer Screening

What is lung cancer screening?

Lung cancer screening is a yearly low-dose CT scan (LDCT) that can show potentially cancerous tumors when they’re still small. LDCT scans take pictures of the insides of your lungs. Screening means that you have a regular test or imaging to catch a disease before it starts causing symptoms.

You might wonder why you’d look for cancer if you don’t have any symptoms. But lung cancer rarely causes symptoms in the early stages, when it’s easier to treat. Lung cancer is often found in later stages, when survival rates are lower.

You should start getting screened at age 50 if you currently smoke or quit within the past 15 years. While anyone can get lung cancer, people who smoke or used to smoke are at a higher risk.

Lung cancer screening guidelines

Healthcare providers recommend that you get a low-dose CT scan for a lung cancer screening every year if you meet all of the following:

• You’re between the ages of 50 and 80.
• You currently smoke or quit within the last 15 years.
• You have a 20-pack year* (at minimum) smoking history.

*To calculate your “pack-years,” multiply the number of years you’ve smoked by the number of packs (20 cigarettes) you smoke each day. For instance, a 20-pack year smoking history could mean you’ve smoked a pack a day for 20 years or that you used to smoke two packs a day for 10 years. Ask a healthcare provider if you aren’t sure how to figure out your pack-year history.

The United States Preventive Services Task Force (USPSTF), a group of healthcare experts, developed these guidelines based on the most recent lung cancer screening studies.

How does lung cancer screening work?

Lung cancer screening works by getting pictures of the inside of your chest. The pictures don’t diagnose cancer on their own, but they can show small masses that can then be tested for cancer.

How do I prepare for a lung cancer screening?

You usually don’t need to do anything to prepare for a lung cancer screening CT scan, but ask your healthcare provider to make sure they don’t have instructions for you. You might want to wear clothing that’s easy to change out of and minimal jewelry. Let your provider or the staff at the imaging center know if you’re sick, especially with a respiratory illness. They may have you reschedule your scan to make sure it’s as accurate as possible.

What happens during a lung cancer screening test?

During a lung cancer screening test:

1. The technician performing the scan will have you remove jewelry, watches or metal items. They may have you change into a gown from the waist up.
2. You’ll lie on a bed that goes into the scanner.
3. The bed will slide into a scanning machine that looks like a tube or a donut.
4. The scanner will rotate around you and the table might move forward and backward while the scanner takes pictures.
5. The technician will tell you either to breathe in or breathe out and to hold your breath at certain points during the scan. Follow their directions as closely as possible. The technician won’t be in the scanning room with you, but they’ll be right outside and talking to you through a microphone.
6. When the provider has all the images they need, the bed will slide out of the scanner so you can get up.

What happens after a lung cancer screening test?

There are no special instructions you have to follow after an LDCT.

What are the risks of lung cancer screening?

Risks of lung cancer screening include:

• False positives. The scan may detect something in your lungs that looks like cancer, but isn’t. For example, most pulmonary nodules (small masses of lung tissue) are harmless. Getting more tests, including surgery, before you know whether a growth is cancer or not can be stressful.
• You might get treatment for a growth found during screening that would never have caused symptoms or spread.
• Radiation exposure. The amount of radiation the LDCT scans expose you to is small, but it’s not zero. Repeated exposure to radiation can increase your risk for cancer.

Sometimes, scans show conditions that your provider wasn’t looking for as a part of a lung cancer screening (incidental finding). These could include conditions that need treatment, like COPD (chronic obstructive pulmonary disease) or a breast mass. But incidental findings don’t always need treatment and can lead to unnecessary tests and stress.

What are the advantages of lung cancer screening?

The advantages of lung cancer screening with low-dose CT include:

• Providers can see smaller tumors on a CT than on a plain X-ray. Studies using plain X-rays to screen for lung cancer suggest that it isn’t as effective at catching cancer early or improving survival rates as LDCT.
• LDCT has a lower dose of radiation than a standard CT (computed tomography scan).

What type of results do you get from a lung cancer screening?

A radiologist and your healthcare provider will review your scans and you’ll get a report with the results. Your radiologist might use these descriptions in your lung cancer screening results:

• Negative. They didn’t see anything on your scan that looked potentially cancerous.
• Benign. This describes nodules (growths) that don’t appear cancerous.
• Probably benign. This describes nodules that don’t appear cancerous, but follow-up imaging is recommended to be sure.
• Suspicious. These are nodules that look like they could be cancer. You’ll need follow-up imaging and possibly a biopsy.
• Very suspicious. These are nodules that look like cancer. You’ll need follow-up imaging and a biopsy. Your provider will refer you to an oncologist who specializes in lung cancer.
• Significant or potentially significant. A radiologist might use “significant” or “potentially significant” to describe something they see that’s not cancer but might need additional imaging or testing.
• Incomplete. They couldn’t evaluate your scan. This might be because you have a lung infection or they need to compare it to a previous scan. You might need another scan in a few months to get an accurate screen.

When should I know the results of a lung cancer screening?

The length of time it takes to receive lung cancer screening results can vary. If you need immediate follow-up, you’ll usually hear from your provider quickly. Otherwise, it might be anywhere from a day to several days. Ask your provider when you can expect the results.

If the results are abnormal, what are the next steps?

Your provider will discuss the results of your lung cancer screening with you. If necessary, possible next steps could include:

• An LDCT scan in three to six months.
• A follow-up diagnostic CT scan.
• A PET/CT scan.
• Follow-up with an oncologist.
• Follow-up with a pulmonologist (for noncancerous respiratory conditions) or another specialist.

When should I call my doctor?

Talk to your healthcare provider if you think you’re at a higher risk for lung cancer and could be eligible for screening. Don’t hesitate to ask them if you have any questions about low-dose CT or the results of your screening.

When can I stop getting screened for lung cancer?

You can stop yearly screenings for lung cancer if any of these are true:

• You’re 81 years old or older.
• You haven’t smoked in 15 years or longer. Your risk for lung cancer goes down as more time passes since your last cigarette.
• You’re unable (due to a health condition) or would choose not to have surgery for early-stage lung cancer.

Is lung cancer screening worth it?

Lung cancer screening increases the likelihood that if you do develop lung cancer, you’ll be diagnosed at an early stage when it’s more treatable. Studies suggest that over 50% of people (or 1 in 2) diagnosed with lung cancer through annual screening are diagnosed at an early stage, compared to about 28% of all people diagnosed with lung cancer at an early stage.

Does lung cancer show up in blood work?

There are no blood tests that screen for or diagnose lung cancer.

A note from Cleveland Clinic

Lung cancer is a serious diagnosis. But annual screening can be a powerful tool for catching it early, with the most effective treatment options available. Talk to your provider about whether you’re at a higher risk for lung cancer and if you should get screened. It could save your life.