What Is the Official Status of Screening for Lung Cancer?
Today no official organization recommends that routine screening be performed on individuals at a high risk of developing lung cancer. This is because clinical trials that were designed to evaluate whether screening for lung cancer helped detect the cancer earlier have not convincingly demonstrated that early detection improves survival in individuals at risk for developing the disease.
Guidelines and Methods for Lung Cancer Screening
Despite the alarming numbers of men and women affected by lung cancer each year in the United States, there is no consensus today among medical professionals on the benefits of routine screening. This is despite the fact that lung cancer commonly goes undetected until it has progressed to a point that it can no longer be cured. For this reason the development of accurate screening methods to detect lung cancer early, before symptoms arise, is critical.
So who should be screened for lung cancer today, and what tests should patients request from their healthcare providers?
Individuals who have been identified as having an increased risk of developing lung cancer—those with a long smoking history and those with a family history of early lung cancer—should speak with their physicians about regular screening. People who have never smoked and have no family history of lung cancer are not candidates for regular screening. Should any symptoms develop, however, speak to your healthcare provider immediately.
The bottom line: Patients at a high risk of developing lung cancer should discuss the pros and cons of cancer screening with their physician.
Methods of Screening
Chest X-rays
Annual chest X-rays will detect lung cancer in earlier stages.
Computerized Tomography
Low-dose computerized tomography (CT) is currently the most sensitive test available for screening for lung cancer. This computerized X-ray system delivers very detailed pictures.
What About Reimbursement for Screening Tests?
Unfortunately, at present most insurers and Medicare do not pay for lung cancer screening tests. Patients at a high risk for lung cancer who are not participating in a study have to pay for the CT screening tests. Annual chest X-rays, however, are probably considered “standard of care” and are thus covered by insurers and Medicare. This should be the minimum screening for high-risk individuals.
Summary
Clinical studies indicate that annual low-dose CT scans appear to be the most practical and sensitive method for screening for lung cancer, although there is no definitive proof that CT scans or any other current method of screening will lower the death rate from the disease. But given the current data, all patients at a high risk of lung cancer should be given the option of an annual CT screening. Though there is a risk of false-positive tests, this can be minimized by biopsy of only stable or growing nodules. Physicians should assume responsibility for informing high-risk patients about screening options, and patients at risk should be informed that although symptomatic lung cancer is incurable, early diagnosis (before symptoms arise) offers a chance for cure. Screening offers the best opportunity for early diagnosis and should be recommended for all patients at risk.
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