If you have read the prior sections, reviewed the information on your individual risk of lung cancer and would consider participating in a CT screening program, the first thing that you need to know is what your benefits might be.
The benefits to be discussed are conditional. They apply to an individual who agrees to
-participate in a lung cancer screening program that meets quality standards and uses a diagnostic algorithm (like IELCAP) or a clinical practice guideline ( like NCCN),
-agrees to have a low-dose, non=contrast, spiral CT scan at yearly intervals for ten years
-follows program recommendations for further testing or biopsy and treatment.
It is probable that a person who stops being screened or does not follow recommendations, based on CT findings, will experience lower benefit and / or higher risk.
A person who is fortunate and does not get lung cancer will receive no direct benefit from screening. He or she might derive indirect benefit. (This will be discussed in a future post.)
A person who is unfortunate and does get lung cancer over the next ten years will have direct benefits.
– The Lung cancer will typically be detected at an earlier point in time, before the cancer would otherwise have been diagnosed at the first onset of symptoms. The is called a “lead=time effect”.
The large majority of lung cancers found in patients who have no symptoms but are at increased risk are found at a smaller size than those diagnosed after symptom onset. Often they are 1 centimeter in diameter (the size of a marble), or smaller (compared to a 3 centimeter (golf ball size or often much larger ) cancer in unscreened individuals.
The large majority of lung cancers found in CT screening are in early stage. More than 80% of CT screen-detected lung cancers are diagnosed in stage 1. In stage 1 lung cancers that are very small, e.g. one centimeter, approximately 90% are in stage 1.
When a lung cancer is found at a small size and early stage, the cancer, in most cases, has not yet spread (metastasized) to lymph nodes or distant organs.
Treatment is, accordingly, more simple and easily-tolerated. Increasingly, surgeons remove small lung cancers using “minimally invasive” techniques, including video assisted thoracic surgery (VATS) and robotic surgical methods. Minimally invasive surgery results in shorter hospitalization, low rates of complication and death, and faster recovery.
In many instances, smaller amounts of lung tissue (limited resection) rather than removal of an entire lobe of the lung (lobectomy) can be performed, without compromising the chance of cure.
Chemotherapy is seldom needed.
Of greatest importance, the chance of cure in patients with lung cancer detected by CT screening exceeds 80%, approximately five times higher than in unscreened patients.