Part I: Introduction & Background
Those of us who have been diagnosed with lung cancer know all too well this disease’s grim survival statistics. We now have a secret weapon that could significantly increase survival rates – screening. The only problem is it should not be a secret. But the reality is that the people who would most benefit most from screening do not know about it. Years of advocating for screening will be worthless—unless those who could benefit are made aware of lung cancer screening.
Why do those of us already diagnosed with lung cancer need to learn about lung cancer screening now? Is not the proverbial cow already out of the barn? While it may be too late for us to be screened, it is not too late for your family and friends who are at high risk. Who better to share with them about lung cancer than someone who speaks from their personal lung cancer experience?
National Lung Screening Trial
Today’s screening guidelines are primarily based on the largest and most comprehensive study of its kind. The National Lung Screening Trial compared screening techniques of more than 53,000 people considered to be at high risk for lung cancer. The goal of the trial was to determine if CT scans were more effective than chest X-rays in detecting lung cancer early and, therefore, helpful in extending life. Half of the participants received an annual chest X-ray and half received an annual low-dose CT scan. The participants in the trial were between the ages of 55-74 with a heavy or long-term smoking history.
The group receiving annual CT scans showed a significantly reduced mortality rate than the group receiving chest X-rays. The results were so dramatic the National Cancer Institute ended the trial early, based on an independent data and safety monitoring board that concluded the trial had proven that screening can significantly save lives without causing undue harm.
Screening Qualifications: Age and Smoking History
Age and smoking history determine if someone is a good candidate for lung cancer screening. Based on the National Lung Screening Trial, the U.S. Preventive Services Taskforce recommends lung cancer screening for the following people:
“…adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.”
Yes, former smokers may qualify for screening. Ironically, many former smokers mistakenly believe that—because they quit—they are somehow immune from lung cancer. However, people who quit smoking within the past 15 years may qualify for lung cancer screening, if they meet the age and smoking history requirements.
Pack-years are calculated by multiplying the average number of packs of cigarettes a person smoked a day by the number of years the person smoked. For example, someone who smoked two packs a day for 20 years has a 40-pack-year smoking history. Or if someone smoked a pack a day for 30 years, they have a 30-pack-year smoking history.
The National Comprehensive Cancer Network has established a different set of screening guidelines for individuals who may have an additional risk factor, such as radon exposure, a previous cancer diagnosis or family history of lung cancer. These more inclusive guidelines allow persons with as few as 20-pack-years, age as low as 50 and to have quit within as many as 20 years ago.
- National Comprehensive Cancer Network Lung Cancer Screening Guidelines for Patients
- New England Journal of Medicine, National Lung Screening Trial
- U.S. Preventive Services Taskforce Lung Cancer Screening Guidelines
Check back soon for Part 2 of Dusty’s article Lung Cancer Screening Saves Lives