Lung Cancer Screening and Lung Nodule Evaluation

More people die from lung cancer than from breast, prostate, and colon cancers COMBINED. For most patients, lung cancer is already at an advanced stage when first detected and cannot be cured. Low dose CT screening can detect lung cancer at earlier stages in high risk patients and decrease risk of death from lung cancer by 20%.



Who should consider lung cancer screening?

  • Adults age 55 or greater
  • Tobacco use > 30 pack year history (1 pack per day or more for at least 30 years)

OR

  • adults age 50 or greater
  • tobacco use > 20 pack year history
  • additional risk factor such as history of cancer, family history of lung cancer, occupational exposure to carcinogens (ie. asbestos, diesel fumes), radon exposure, COPD, or pulmonary fibrosis

Benefits:

  • The National Lung Screening Trial (NLST) studied over 50,000 patients at high risk for lung cancer across 33 U.S. medical centers.
    • Patients were randomized to lung cancer screening with yearly low dose CT versus chest X-ray for 2 years.
    • CT screening decreased the rate of death from lung cancer by 20% and the rate of death from any cause by 6.7%.
    • Many questions remain unanswered, but there will not be a larger or better conducted study on lung cancer screening in the foreseeable future.
  • As of 2012, the National Comprehensive Cancer Network (NCCN) recommends lung cancer screening for high risk patients.

Risks:

  • Almost 25% of high risk patients have abnormalities on screening CT.
  • Only 3-4% of these abnormalities are due to lung cancer.
  • Many patients undergo unnecessary tests and invasive procedures for abnormalities that are not due to lung cancer.

What else do I need to know?

  • Low dose CT screening for lung cancer is NOT yet covered by most insurance companies. CPMC offers low dose screening CTs for $400 which includes the scan and interpretation by board-certified Radiologist.
  • Low dose CT uses 4-5x less radiation than a standard CT and no IV is required.
  • Follow-up of abnormalities detected on screening CT IS covered by most insurance companies if medically indicated.

 

For high risk patients, low-dose CT screening is effective in reducing death from lung cancer. However, the process can be confusing and complicated. As pulmonary physicians specializing in lung nodule evaluation, we have the expertise and experience to guide you through this challenging process to obtain the best outcome.



Focus on Lung Nodules

We have a team of pulmonary physicians that specialize in lung nodule evaluation and diagnosis. We understand that lung cancer often becomes the main concern when lung nodule/s are found on imaging. However, there are many other causes of lung nodules that are not due to cancer. We provide expedited evaluation and diagnosis of patients with lung nodules to rapidly determine the cause of the nodule.

 

Coordination of Care

We are key participants in CPMC Lung Nodule Tumor Board which is co-founded and co-chaired by Dr. Chen. This is a weekly multidisciplinary conference attended by Pulmonologists, Radiologists, Thoracic Surgeons, Medical Oncologists, and Radiation Oncologists to discuss best approach to diagnose lung nodules and treat lung cancer. We collaborate closely with other CPMC physicians to provide the most advanced, least invasive procedures to diagnose and treat lung cancer, including bronchoscopy with endobronchial ultrasound guided needle aspiration (EBUS-TBNA), electromagnetic navigational bronchoscopy, CT guided needle aspiration, video assisted thoracoscopic surgery, and stereotactic radiotherapy.