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Decision Aid For Lung Cancer Screening

AMBULATORY CARE:

Lung cancer screening

is a test done every year to find lung cancer early. Screening is different from diagnosis because screening is used before you have any signs or symptoms. Screening may be helpful if you are or were a heavy smoker, or if you smoked for many years. This is because smoking increases your risk for lung cancer. Lung cancer screening has benefits and risks. Talk with your healthcare provider about the benefits and risks to help you decide if lung cancer screening is right for you.

What you need to know about lung cancer:

  • Lung cancer cells can form a tumor in your lungs and can spread to other areas of your body. This cancer is often found after it has spread. By this time, it is more difficult to treat. Treatment may include surgery to remove lung tissue that contains cancer cells.
  • Lung cancer is the leading cause of cancer deaths. Each year, about 220,000 people find out that they have lung cancer. About 150,000 people die each year from lung cancer.
  • Half of the people who have lung cancer are over the age of 70. The most common age of people who die from lung cancer is 72.
  • Talk to your healthcare provider if you think you have signs or symptoms of lung cancer. Examples include chest pain, a cough that does not go away, coughing up blood, wheezing, hoarseness, and neck swelling.

How to know if you are a good candidate for lung cancer screening:

You may be able to have lung cancer screening if the following are true:

  • You are between 55 and 80 years old.
  • You have never had lung cancer.
  • You do not currently have any signs or symptoms of lung cancer.
  • You currently smoke, or you quit less than 15 years ago. You also are or were a heavy smoker (30 pack-years or more).
  • You do not have any other serious conditions that may affect how long you live.
  • You are willing to have surgery if screening shows signs of lung cancer.
  • You are willing to have screening every year until you have not smoked for 15 years or reach 81 years of age. Screening may also stop if you develop another health condition or you are no longer willing to have treatment.

Pack-years:

Pack-years are the number of cigarette packs you smoked multiplied by the number of years you smoked. A heavy smoker has 30 pack-years or more. Examples of 30 pack-years are 1 pack of cigarettes smoked each day for 30 years, or 2 packs each day for 15 years. Your healthcare provider can help you calculate your pack-years.

How lung cancer screening is done:

Lung cancer screening is done with a low-dose CT scan (LDCT). A CT uses an x-ray and a computer to give detailed pictures of your lungs. You will lie on a table for this test. A low amount of radiation from the x-ray machine is used to take pictures of your lungs. This test only takes a few minutes. You will be asked to hold your breath for about 6 seconds while the pictures are taken.

Benefits of lung cancer screening:

  • LDCT can find some kinds of lung cancer early. This means it can be treated with less invasive surgery, or less lung tissue may need to be removed.
  • The scan is not invasive or painful, and takes only a short amount of time.
  • LDCT does not leave radiation in your body after the scan is done.
  • LDCT can lower your risk of death from lung cancer by 16% to 20% because the cancer is found early. Your risk for death from any cause is lowered by 6.7%. This is because the scan may show signs of problems other than lung cancer that need to be treated.

Risks of lung cancer screening:

  • LDCT exposes you to a small amount of radiation that can increase your risk for cancer. The amount is less than is given during a mammogram. It is about the same amount you get from the sun in a year. Because you will need to be screened every year, your total radiation exposure over time is increased.
  • The test can give a false-positive result. This means that screening shows you have lung cancer, but follow-up tests show that you do not. You may get more tests or even treatments that are not needed. It can also be stressful to think you have lung cancer when you do not. The risk for a false-positive result is about 23%.
  • The test can give a false-negative result. This means the test does not find signs of cancer, but you later develop signs and symptoms and need treatment. A false-negative result can keep you from getting treatment as early as possible. The risk for a false-negative result is about 4%.
  • Screening may lead to over-diagnosis if tumors are found that are not life-threatening. Some forms of cancer grow quickly and need to be treated. Other forms grow slowly and may not be life-threatening in your lifetime.
  • Screening may lead to over-treatment. This means that you get treatment that is not necessary. About 10% of people with lung cancer receive treatment that was not needed.

What happens after lung cancer screening:

You will meet with your healthcare provider to go over the results of your screening. You may need more tests to diagnose anything that showed up on the screening test. Lung cancer screening needs to be done each year. Even if your result shows you do not have lung cancer, it is important to continue getting screened each year. This is the best way to find a new cancer, at the earliest possible stage.

Questions to ask your healthcare provider to help you make a decision about screening:

  • How high is my risk for lung cancer?
  • What are my pack-years?
  • Will I be able to help create my treatment plan if screening shows I have lung cancer?
  • Will my insurance cover screening?
  • Where is the screening done?
  • Do I need to do anything to get ready to have screening?
  • When and how do I get the results of my screening?

What to think about before you decide if you will have lung cancer screening:

  • Benefits and risks of lung cancer screening:
    • Do I understand the benefits and risks of lung cancer screening with LDCT? How concerned am I about the risks? Do I think the benefits are greater than the risks?
    • One of the main risks is that the radiation I get during screening can cause cancer. Do I understand how high the risk is? How worried am I about the risk?
  • Possibility of finding lung cancer: How will I feel if I find out I have lung cancer? Am I willing to get the treatment I might need?
  • Possibility of false results: I might get a false-positive or false-negative result. How will I feel if the test results are wrong?
  • Need for annual screening: Screening needs to be done every year. Am I willing to have screening until I am a nonsmoker for 15 years, am 81, or develop another condition? Screening will also stop if I am no longer willing to have treatment. How do I feel about the need for surgery or other treatment for lung cancer? Will I be comfortable with my decision not to have treatment, and to stop having screening?

What you need to know about quitting smoking:

If you currently smoke, it is very important that you quit. If you already quit smoking, it is important that you do not start smoking again. You will also need to avoid secondhand smoke from others. Nicotine and other chemicals in cigarettes and cigars increase your risk for cancer. Your risk for lung cancer gets lower each year that you do not smoke. Even if you get lung cancer screening every year, it is still important not to smoke. Ask your healthcare provider for information if you currently smoke and need help to quit. You can find support and more information here:

  • Smokefree.gov
    Phone: 1- 800 - 784-8669
    Web Address: www.smokefree.gov

For support and more information about lung cancer:

  • American Lung Association
    1301 Pennsylvania Ave. NW
    Washington , DC 20004
    Phone: 1- 202 - 785-3355
    Phone: 1- 800 - 548-8252
    Web Address: www.lung.org

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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