Should you get screened for lung cancer? The answer may surprise you

If you quit smoking long ago, you probably haven’t given a low-dose CT scan for lung cancer a thought. But, if you are like most Americans, you might be surprised by who qualifies for one.

For example, if you are 70 and smoked a pack a day from the ages of 18 to 38, that counts as 20 pack years. Despite the fact that you quit 32 years ago, you qualify for the scan.

“There are a lot of former smokers out there and they have decreased their risk, but it still pays to get scanned,” said Cape Cod Hospital thoracic surgeon Jeffrey Spillane, MD, FACS. “I see a lot of people who smoked in the 1960s and 1970s when it was normalized, and sort of a Virginia Slims country and that’s what you did. A lot of folks quit smoking. But that risk still doesn’t go to zero.”

The guidelines for testing used to be anyone over the age of 60 and under 85 who has smoked for 30 pack years (packs smoked per day times number of years smoked). Now the guidelines allow for anyone over the age of 50 with no upper limit and the number of pack years has been lowered to 20 years.

Lung cancer is the leading cause of cancer deaths in the United States, yet only 29 percent of Americans are aware of that fact. The reason it is so deadly is because most of the cancers are found at later stages.

“Tumors in the chest are almost completely asymptomatic,” Dr. Spillane said. “They don’t cause problems until they either get to the chest wall, which causes pain, or until somebody coughs up blood, which usually occurs with a very large tumor. Or the disease spreads to some other organ that causes problems. Unfortunately, you can be walking around with a golf-ball-sized tumor with no symptoms and that happens all too frequently.”

Nearly 70 percent of Americans aren’t aware that low-dose CT scan screening is available to detect early cancer. Perhaps because of that, the American Lung Association estimates that nationally only about 5.7 percent of those who qualify for screening actually get it. Massachusetts has the best screening rates in the country, at 17.8 percent, but that still leaves a lot of room for improvement.

Lung Cancer Treatment Advances

Earlier detection can save lives, but even those with late cancers shouldn’t despair. In the past 10 to 15 years, treatment has expanded to offer more successful outcomes, he said.

Now, there is immunotherapy, precise radiation therapy and good ablation procedures as treatment options.

After Dr. Spillane does a lobectomy robotically, patients can go home after spending just two to three days in the hospital. Chemotherapy has also gotten better, with new treatments and less side effects, such as nausea.

“People who are treated even in the advanced stages, on average, live longer and, even more importantly, report a better quality of life,” Dr. Spillane said. “It’s a much different disease than it was even 10 years ago. It’s eminently more treatable now.”

In fact, in the past 10 years, the lung cancer survival rate has increased more than 30 percent.

Quitting Smoking

Part of the reason so few people get lung scans as opposed to mammograms is the stigma that comes from smoking, Dr. Spillane said. Almost everyone who smokes knows they should quit. Most people are embarrassed to talk to their doctor about it because they don’t want their doctor to scold them. And if a cancer is detected, people can be judgmental about lung cancer in a way that they never are with breast or colon cancer because there is a perception that the person brought it on themselves.

Dr. Spillane said he never judges patients who are current or former smokers. He realizes there are many reasons why people smoke, from life circumstances to mental health issues. Also, once someone starts, it’s highly addictive and difficult to quit.

He tries to get patients who are current smokers to cut down to half of what they usually smoke. When that levels off and you are used to the lower amount of nicotine, he suggests cutting it in half again. The most successful way to use this method is to count out the cigarettes in the morning and promise yourself you won’t smoke more than the allotment.

The goal is to eventually get down to zero, but even cutting down on the number of cigarettes can reduce risk because the more you smoke the more risk you have, said Dr. Spillane.

Even though smokers get lung cancer seven times as frequently as non-smokers, Dr. Spillane has seen a rise in the number of never smokers who are diagnosed. One of the reasons is they are doing more screening than they have in the past, so they are catching more cancers. The current scans are higher definition, so more cancers can be detected at earlier stages. Another factor is that people are living longer, and your risk of any cancer increases with age.

In addition to smoking, other risk factors for lung cancer include a family history of the disease, growing up in a house where people smoked, and radon exposure. For example, a lot of people growing up in the Connecticut River Valley were exposed to radon, Dr. Spillane said. As far as he knows, there is no radon on the Cape, but so many people who live here grew up somewhere else.

There are several reasons that screening for lung cancer lags behind other screenings. In the 1970s, researchers decided that, at that point in time, any money to prevent lung cancer would be better spent on the prevention of smoking and programs to help people quit, explained Dr. Spillane. The biggest reason for that conclusion was that the only screening tool physicians had at the time was chest X-ray, which was not very good at detecting early cancers.

When the more effective diagnostic device, CT scan, came along, the early ones were expensive, and their radiation dose was high. As the technology improved, the scans began to have better resolution and emitted much lower radiation levels. They also become more affordable.

“At the time, it was a public awareness choice and not a clinical one,” Dr. Spillane said. “Now we feel like we have done the public awareness, so it’s time to spend money on the clinical side.”

Dr. Spillane advises all people who currently smoke or have smoked at some time in the past, as well as people with a family history of lung cancer, to discuss screening with their primary care doctor.

“I think it’s a conversation you should have with your primary care doctor,” he said.

Learn more about lung care at www.capecodhealth.org/lung-care.