This story was originally published in January of 2017.
Since the 1950s experts have known about the link between smoking and lung cancer, but for decades, there was no reliable and safe way to screen those who were at highest risk of developing the disease.
That all changed in 2011, when the results of the government-sponsored multicenter National Lung Screening Trial (NLST) were published in the New England Journal of Medicine (NEJM) showing that for current and former smokers at highest risk of developing the disease, the use of low-dose CT screening was associated with a reduction in lung cancer-related death by 20%.
Based on those findings, Memorial Sloan Kettering — like several other hospitals — launched a lung cancer screening program. Yet many of the people who would benefit most from screening are still not getting it.
Bernard Park and Michelle Ginsberg, who together lead MSK’s screening program, hope to change that. We spoke with Dr. Park, a thoracic surgeon, and Dr. Ginsberg, a radiologist, about some of the myths and misconceptions surrounding lung cancer screening, and about what individuals who smoke or used to smoke should know about getting screened.
Myth: If I quit smoking, I am no longer at risk and don’t need to undergo lung cancer screening.
Based on the research, screening is recommended not only for current smokers but also for former smokers who have quit smoking less than 15 years ago, depending on the extent of their tobacco exposure.
More specifically, screening is recommended for people who are between the ages of 50 and 80 and have smoked the equivalent of 20 or more “pack-years.” The pack-years figure is calculated by multiplying the number of years smoked by the number of packs smoked per day. For example, one pack a day for 30 years equals 30 pack years, while two packs a day for 20 years equals 40 pack years.
Myth: Lung cancer screening is still considered experimental and is not part of standard care.
After the NEJM study, screening experts realized that the test was beneficial for the high-risk study population of people who currently and formerly smoked. Lung cancer screening is recommended for these patients and is covered by Medicare and Medicaid, as well as by most insurance companies.
Although the NLST study only screened people three times over two years, MSK experts recommend that people undergo annual low-dose CT scans for as long as they meet the screening requirements.
Myth: Lung cancer screening has a high rate of false positives, leading to many unnecessary procedures.
“All cancer screenings carry some risk of false positives, but it is true that the rate is slightly higher for lung cancer screening,” Dr. Ginsberg says. Usually, a false positive means there was something found on the scan that requires you to undergo additional imaging scans. It doesn’t mean you’ll necessarily have to undergo other, more invasive procedures, she notes.
Dr. Park adds that the chance that someone will undergo a surgical intervention such as a biopsy for something that is not cancer is less than 5%.
Myth: The scans used in lung cancer screening expose you to dangerous radiation.
The low-dose CT scans that are used for lung cancer screening have about five times less radiation than conventional CT scans. For the average person, even a regular CT scan is associated with a very small risk of possibly developing a future cancer — perhaps about 0.05%, or about one in 2,000. For people who meet the screening requirements, that potential risk is far outweighed by the benefit, which could save your life.
Furthermore, the test does not require an IV or any injections of contrast dye. There is no preparation and you can eat normally before your scan.
Myth: If lung cancer is found, it will be too late for effective treatment.
“The whole point of screening is to catch the cancer at its earliest stage, before there are symptoms,” Dr. Park says. “Early lung cancer is curable. People should think of this test the same way they think of getting their cholesterol checked, which is something that enables them to intervene early and prevent coronary artery disease.”
According to the International Association for the Study of Lung Cancer, the cure rate for patients diagnosed with stage IA lung cancer — the very form of early stage disease that screening was designed to detect — is more than 75% over a five-year period.
Myth: Lung cancer screening is time consuming.
“We’re all busy, and this can feel like one more thing you have to fit into your schedule,” Dr. Park says. Undergoing the screening may require some effort, he adds, because at some centers it requires two appointments. However, at MSK, only one visit is required.
Before having the scan, you’ll first meet with a licensed independent practitioner (a nurse practitioner, doctor, or physician’s assistant) to ensure that you are eligible and without symptoms of more advanced disease, and to answer any questions and concerns. At MSK, people who qualify for screening can have the test immediately.
The actual screening process takes only a few minutes, Dr. Park says, and results are usually available within 24 hours.
Dr. Park says he believes that the biggest barrier to undergoing screening may be anxiety.
“People are very afraid that something will be found,” he says. “They’re anxious leading up to the test and until the moment that I tell them that everything is OK. It’s important to emphasize that the vast majority of people who undergo the screening don’t have any findings of cancer, but for those who do, this test can save their lives.”
To learn about making an appointment with MSK’s lung cancer screening program, call 646-497-9163. MSK offers screening appointments at most locations in Manhattan, Nassau, Commack, Basking Ridge, Bergen, Monmouth, and Westchester.