Lung cancer screening “decision aid”: Summary
Screening Eligibility Criteria:
If you are
1. a current smoker or
2. an ex-smoker who has quit within the past fifteen years and
3. You have smoked a total of thirty pack/years or more.
(For example, smoked an average of two packs a day for fifteen years or one pack a day for thirty years.)
And
4. You are between the ages of 55 and 80,
Medicare or Medicaid will pay for a low-dose, non-contrast, spiral CT scan for lung cancer screening, each year.
But, only after you have reviewed information in a “decision aid” – like this one- and have gone through “a shared decision making conference” with your caregiver.
This policy is based on the fact that lung cancer is the number one cancer killer in the U.S. in both men and women and has been responsible for many millions of deaths over the past century. Because of your exposure to cancer- causing chemicals in tobacco smoke, you have an increased risk of lung cancer – now – and over the next 10 years.
What is your personal risk of lung cancer?
Your increased risk is substantial and varies between
2-4% on the first scan ( odds of lung cancer between 1 in 50 And 1 in 25) and
10% over a ten year period; (odds of lung cancer 1 in 10) in high-risk patients who meet the Medicare criteria above.
In one study from the University of Toronto, Canada, 21% of high-risk individuals screened over a ten-year period developed lung cancer (odds risk of 1 in 5).
(It is widely anticipated that Medicare and Medicaid will soon extend screening coverage to smokers and ex-smokers starting at age 50 and those who have 20 or more pack/years of exposure based upon a recommendation from the U.S. Preventive Services Task Force (USPSTF).
Benefits of CT Screening:
CT screening has been shown, in multiple studies, to detect lung cancers at small size and early stage (Stage 1) in a high percentage of patients (approximately 80%)
CT screening has been determined, in multiple studies, to reduce deaths and increase the chance of survival for at least ten years, when a lung cancer is found by screening. About 80%, or 4 in 5 lung cancers found by screening can be cured, compared to less than 20% or 1 in 5 without screening.
What are the potential risks of lung cancer screening?
The National Cancer Institute (NCI) was worried that CT screening might cause more harm than benefit and performed a randomized control research trial (RCT) to study risks. Medicare requires that people considering screening must be presented with specific information on potential risks, in a “decision aid”, on the following complications that might arise from screening
1. People might not quit smoking.
2. Screening might be inconvenient
3. Screening might cause discomfort
4. Screening might cause anxiety.
5. There might be false negatives (cancer would be missed.)
6. There might be false positives (tests would be positive without cancer).
7. There might be diagnosis of many lung cancers that would never cause symptoms or kill (
8. Unnecessary tests, biopsies and surgical operations might cause complications and even deaths in patients with false positives or
9. Radiation from CT scans might cause cancers.
10. Results (early stage detection and cure) might be lower in community screening than in academic research.
Multiple research studies, as well as extensive community screening experience in Japan, have shown that the risk of the above complications is small and that benefitS far exceed harms in CT screening.
Specifically-
1. There is no evidence that people who are screened fail to quit or start smoking again.
2. Most areas of the country have screening centers available within reasonable distance.
3. CT screening causes minimal discomfort; less than other forms of screening.
4. Anxiety is relatively minor and is counterbalanced by relief when (most) CTs show no evidence of cancer.
5. False negative scans are uncommon.
6. False positive scans occur in less than 5-12% of patients – in programs using an organized plan of diagnosis and treatment ( for example, NCCN, IELCAP and Lung- RADS.
7. NLST research shows that no more than 1% of lung cancers diagnosed by CT screening are overdiagnosed.
8. Organized diagnostic plans prevent unnecessary diagnostic tests, biopsies and operations in patients with false positive scans results or overdiagnosis.
9. There is no evidence that older patients receiving annual low-dose CT scans have any increased risk of cancer.
10. Many community centers have shown results equivalent to or better than some academic centers. All centers certified by the American College of Radiology, Go2 and Medicare have gone through a rigorous process to assure high quality screening.
In Summary:
Patients with lung cancer found by CT screening have long-term survival that is far higher than those who have not been screened.
Risks of screening are relatively minor and are preventable by good screening practice and patient compliance.
It is generally agreed by multiple screening groups and medical societies that lung cancer screening has the potential to save many lives and has a favorable benefit to risk ratio.
The results described here can be reliably anticipated in patients who return each year for their CT scans and who follow advice, based on diagnostic and treatment plans. Patients who skip scans or do not follow recommendations may experience less benefit and more risk.
Patients who quit more than 15 years earlier remain at high-risk of lung cancer and should consider screening. At the current time, you would have to pay for CT screening.
Smokers of less than 20 years, those exposed to heavy second-hand smoke, industrial chemicals, asbestos and radon have an increased risk of lung cancer and may benefit from screening, but would have to pay for the CT scan out of pocket. Depending on the center, this cost may vary between $100 -$500.
After thinking about the information above, if you decide that you wish to be screened for lung cancer, you must schedule a “shared decision making” consultation with your doctor, before Medicare/Medicaid will agree to pay for the scan.
The American College of Chest Physicians have recommended that lung cancer screening not be conducted during the COVID epidemic. There is no data to support this recommendation. Multiple screening programs (including Mount Sinai Hospital in NYC and City of Hope in Duarte, CA) are actively screening now, without evidence of COVID infections.
Your doctor must write a prescription for your scan and the CT scan must be obtained at a center approved by Medicare.
If you would like to look at more information on benefits and risks of CT screening, please continue on to visit other pages in lungcancerCTscreening.com, that provide more information on benefits and risks of CT lung cancer screening.