- What is lung cancer?
- What are the risk factors for lung cancer?
- Do we know what causes lung cancer?
- Can lung cancer be prevented?
- Can lung cancer be found early?
- American Cancer Society guidelines for lung cancer screening
- Signs and symptoms of lung cancer
- Exams and tests to look for lung cancer
- Additional resources for lung cancer prevention and early detection
- References: Lung cancer prevention and early detection
Can lung cancer be found early?
Usually symptoms of lung cancer do not appear until the disease is already in an advanced, non-curable stage. Even when symptoms of lung cancer do appear, many people may mistake them for other problems, such as an infection or long-term effects from smoking. This may delay the diagnosis.
Some lung cancers are diagnosed early because they are found by accident as a result of tests for other medical conditions. For example, lung cancer may be found by imaging tests (such as a chest x-ray or chest CT scan), bronchoscopy (viewing the inside of lung airways through a flexible lighted tube), or sputum exam (microscopic examination of cells in coughed up phlegm) done for other reasons in patients with heart disease, pneumonia, or other lung conditions. A small portion of these patients do very well and may be cured of lung cancer.
Screening is the use of tests or exams to detect a disease in people without symptoms of that disease. Doctors have looked for many years for a test to find lung cancer early and help people live longer, but only in recent years has a study shown that a lung cancer screening test can help lower the risk of dying from this disease.
The National Lung Screening Trial
The National Lung Screening Trial (NLST) was a large clinical trial that looked at using a type of CT scan known as low-dose CT (sometimes called low-dose spiral or helical CT) to screen for lung cancer. CT scans of the chest provide more detailed pictures than chest x-rays and are better at finding small abnormalities in the lungs. (Both of these tests are discussed in more detail in the section “Exams and tests to look for lung cancer.”) Low-dose CT (LDCT) of the chest uses lower amounts of radiation than a standard chest CT and does not require the use of intravenous (IV) contrast dye.
The NLST compared LDCT of the chest to chest x-rays in people at high risk of lung cancer to see if these scans could help lower the risk of dying from lung cancer. The study included more than 50,000 people aged 55 to 74 who were current or former smokers and were in fairly good health. To be in the study, they had to have at least a 30 pack-year history of smoking. A pack-year is the number of cigarette packs smoked each day multiplied by the number of years a person has smoked. Someone who smoked a pack of cigarettes per day for 30 years has a 30 pack-year smoking history, as does someone who smoked 2 packs a day for 10 years and then a pack a day for another 10 years. Former smokers could enter the study if they had quit within the past 15 years. The study did not include people if they had a prior history of lung cancer or lung cancer symptoms, if they had part of a lung removed, if they needed to be on oxygen at home to help them breathe, or if they had other serious medical problems.
People in the study got either 3 LDCT scans or 3 chest x-rays, each a year apart, to look for abnormal areas in the lungs that might be cancer. After several years, the study found that people who got LDCT had a 16% lower chance of dying from lung cancer than those who got chest x-rays. They were also 7% less likely to die overall (from any cause) than those who got chest x-rays.
Screening with LDCT was also shown to have some downsides that need to be considered. One drawback of this test is that it also finds a lot of abnormalities that have to be checked out with more tests, but turn out not to be cancer. (About 1 out of 4 CT scans in the NLST showed such a finding.) This may lead to additional tests such as other CT scans or more invasive tests such as needle biopsies or even surgery to remove a portion of lung in some people. These tests can sometimes lead to complications (like a collapsed lung) or rarely, death, even in people who do not have cancer (or who have very early stage cancer).
LDCTs also expose people to a small amount of radiation with each test. It is less than the dose from a standard CT, but it is more than the dose from a chest x-ray. Some people who are screened may end up needing further CT scans, which means more radiation exposure. When done in tens of thousands of people, this radiation may cause a few people to develop breast, lung, or thyroid cancers later on.
The NLST was a large study, but it left some questions that still need to be answered. For example, it’s not clear if screening with LDCT scans would have the same effect on people different from those allowed in the study, such as those who smoke less (or not at all), or people younger than age 55 or older than 74. Also, in the NLST, patients got a total of 3 scans over 2 years. It’s not yet clear what the effect would be if people were screened for longer than 2 years.
These factors, and others, need to be taken into account by people and their doctors who are considering whether or not screening with LDCT scans is right for them.
Last Medical Review: 08/22/2014
Last Revised: 11/10/2014