Lung Cancer Screening Saves Lives (Part 2)

Check out Part 1 of Dusty's article Lung Cancer Screening Saves Lives

Part II: What to Expect

Lung cancer screening is done by a low-dose CT scan (LDCT). Low-dose refers to the lower than normal radiation exposure from the CT scan, also called a CAT scan. The scan takes a series of spiral images of the inside of the body, of course, with a focus on the lungs. However, incidental findings, such as heart problems, have been discovered and helped save lives.

Insurance Coverage

Many lung cancer advocates, myself included, advocated for lung cancer screening to be covered by insurance. This was a hard-fought battle especially because Medicare’s preliminary recommendation was that lung cancer screening NOT be covered. Advocates united with one voice and won that battle.

Nevertheless, before your scan, confirm with your insurance that you are covered for lung cancer screening. To date, for people who meet the age and smoking history screening guidelines outlined in Part I of this article, lung cancer screening is 100 percent covered by insurance with no co-pay or out-of-pocket expense. Medicare, Medicaid and most private insurers must cover lung cancer screening. (NOTE: We will track changes, if any, with proposed repeal of the Affordable Care Act.)

Shared Decision Making

A physician must prescribe the CT scan based on the patient age, smoking history and other health factors.  The provider will initiate a “shared decision making” discussion about the benefits and risks of screening for lung cancer. If the patient is a current smoker, the provider will also explain the value of smoking cessation and offer advice and tools to help the patient quit.

A CT machine is shaped like a huge doughnut that passes over the section of the body to be screened. Since the scanning device is open, unlike an MRI, it should not be a problem for people who are claustrophobic.

Oftentimes, patients can remain in their own clothes while being scanned. But if not, you will be given a gown to wear. The scan itself takes less than five minutes. The technician will help you get comfortable on the CT table. (They may even offer you a warm blanket! I always accept, if offered.) You will likely be asked to raise your arms above your head. When you are in position for the scan, the technician will leave the room but he/she will be able to see you and communicate with you from the other room. During the scan, just follow the recorded instructions, such as “Hold your breath” and “Breathe.”

Before you know it, the procedure will be over! The next part may be the most difficult. That is waiting for the results. During the shared decision making discussion, ask your provider to explain how long it will be from the time you receive your scan until you receive the results.

Problems

One of the drawbacks with lung cancer screening is that CT scans can detect tiny nodules in the lungs that may be harmless. Discovering these nodules may cause emotional turmoil to the patient or lead to further, more invasive, diagnostics before determining whether the nodule is harmless.

Scientists and researchers are addressing this issue. Since many of the nodules ultimately proven to be harmless are small in size, some scientists have proposed setting a standard for increasing the size of what is classified as a suspicious nodule. If a nodule is small, the provider may watch over time to see if the nodule changes before having the patient undergo further diagnostics or unnecessary invasive procedures. Understanding the fact that the CT often detects small harmless nodules can help offset any anxiety caused when nodules are found on your CT scan.

There is a practical reason that lung cancer screening is not for everyone. Even though screening is with low dose of radiation, there are risks associated with radiation exposure. There is a significant benefit for those people who meet the definition of “high risk” for lung cancer. However, for others, unfortunately, the risk does not outweigh the benefit.

In the meantime, take heart. Scientists are researching safe ways—such as through blood or breath analysis—to detect lung cancer early in those who do not qualify for lung cancer screening by low-dose CT.

Share Information

Lung cancer screening by low-dose CT is recommended annually. Once you get the first one under your belt, you will be a pro. If you have family members or friends who you think may benefit from lung cancer screening, please share what you have learned with them. You may save their life.