Editor’s note: This story originally ran April 17, 2019 and was updated Oct. 31, 2022 to reflect updated screening guidelines.
Lung cancer is the third most common cancer in men and women in the United States and the leading cause of cancer death. Lung cancer is so deadly because it usually does not cause any symptoms until it’s too advanced and can’t be cured. That’s why lung cancer screenings are important.
Who Should Get a Lung Cancer Screening
Lung cancer screenings are designed to detect lung cancer in individuals who do not have any symptoms of the disease. If lung cancer is found early, it’s easier to treat. However, lung cancer screening is not currently offered to everyone. So how do you know if you should be screened?
Lung cancer screenings are for people who:
- Are aged 50 to 80 years (50 to 77 years if you have Medicare)
- Currently smoke or have quit within the past 15 years
- Are not experiencing clinical signs or symptoms of lung cancer
- Have at least a 20 pack year smoking history
A pack year measures the amount you have smoked over a long period of time. To calculate this number, multiply the number of packs you smoke per day by the number of years you smoked.
“For example, if you smoked one pack per day for 30 years, that’s 30 pack years smoking. Or if you smoked two packs per day for 15 years, that gives you 30 pack years smoking,” says UNC REX pulmonologist Hiren Mehta, MD.
If you meet the screening criteria, you should be screened once a year until you no longer meet the criteria.
“For example, if you smoked but quit 10 years ago, then you still get an annual screen for the next five years until you hit that 15-year mark, then you no longer need screening every year,” Dr. Mehta says.
Where to Get a Lung Cancer Screening
Screenings are available at radiology offices and hospitals and require a referral from your doctor. Painless and fast, a screening includes a low-dose CT scan and a clinical evaluation. Low dose means a lower amount of radiation is needed than what is used for a diagnostic CT scan.
“It’s a little bit more than an X-ray, but it’s considerably less than a regular chest CT,” Dr. Mehta says. “For screening, studies have shown using lower-dose radiation is sufficient to identify abnormal nodules or masses in a lung.”
Once you are referred for a screening, your doctor will talk to you about smoking cessation programs if you are still a smoker and also review the pros and cons of screening.
The Pros and Cons of Lung Cancer Screening
The downsides to screening include exposure to radiation and false positives, which means finding something that appears suspicious but isn’t actually cancer.
“Sometimes it creates a significant amount of anxiety when someone finds out they have a spot on the lung, which is very common, and it turns out not to be cancer,” Dr. Mehta says.
If your screening shows something suspicious, your doctor will talk to you about your options. “We try to assess risk based on the size and appearance of the nodule itself, smoking history along with personal or family history of lung cancer,” Dr. Mehta says. “Depending on the patient’s history, smoking history and risk factors, we will either go with a biopsy (to test the mass) or surgical resection (removal).”
And while false positives are a problem, research shows they only lead to unnecessary procedures a fraction of the time. Ultimately the life-saving benefits of screening outweighs the risks, Dr. Mehta says.
“The symptoms of lung cancer are significant, unexplained weight loss, new and persistent voice hoarseness, coughing up blood or a cough that persists for months. If you have any of these symptoms, you need to see a doctor to be evaluated before you can have a lung cancer screening,” Dr. Mehta says.