Lung Cancer screening: Are you eligible?

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Lung Cancer screening: Are you eligible?

Lung Cancer screening

So are you eligible for Lung Cancer Screening? Lung cancer is the third most common cause of cancer death in India. It is also the third most common cancer in males. The most concerning reason for lung cancer is either direct smoking or passive smoking, where a normal human stays exposed to excess environmental smoke causing severe effects on the lungs.

Around 60 percent of patients diagnosed with lung cancer will not survive for more than 6 months. About 2/3rd patients with lung cancer present in the advanced stage that is not amenable to cure. However, if detected in early-stage, lung cancer has a better prognosis and can be treated completely. Early detection can be done with the help of screening.

To have a detailed analysis of the patient’s situation without depending on his symptoms or history, screening helps in testing for the disease with detailed comprehension. Doctors recommend a screening test to find a disease early, when treatment may work better.

Frequently Discussed Questions

Q1. What are the tests available for lung cancer screening?

There are three tests that have been studied for lung cancer screening. These are chest x-ray, sputum cytology and low dose CT scan. Only a low dose CT scan has been recommended as a screening modality.

Q2. Who should get screened?

U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery.

Q3. What is low dose CT scan?

A low-dose spiral chest CT scan differs from a regular CT scan in numerous key ways. Considering the full-dose CT scan, the low-dose CT scan emits one-fifth of the radiations which could be absorbed during the scan. Understanding the screening frequency of lung cancer patients, a low-dose CT scan is considered safer which is on both hands crucial and necessary.

According to a recent study on risk analysis of Low-dose CT scan exposure accumulation, the study was conducted over a period of 10 years and it showed almost negligible lifetime risks to the patients. It pointed near-around only 2 men out of 10,000 and 6 women out of 10,000 showed risks progress. However, the number of lung cancer diagnoses with the screening was much higher: about 500 lung cancer cases per 10,000 screened people.

Lung Cancer cases detected by low-dose CT scan far outweigh the risk of radiation. The risk analysis is though considerable but also the increased risk of developing cancer from the screening is not substantial.

Q4. How to calculate pack-year?

Number of pack-years = (number of cigarettes smoked per day/20) × number of years smoked.

Q5. When should the screening stop?

  • Turns 81 years old, or
  • Has not smoked in 15 or more years, or
  • Develops a health problem that makes him or her unwilling or unable to have surgery if lung cancer is found

Q6. What are the harms of screening?

Though screening with low dose CT scan is associated with a 20% reduction in lung cancer-specific deaths, still there is much harm associated with it.

Considering the harm, lung cancer screening is only recommended for adults, who could be exposed to risks of developing cancer because of their smoking history and age.

False-Positive Results: A lung cancer screening test can suggest that a person has lung cancer even in the absence of any cancer traces. This is called a false-positive result. False-positive results could lead to cascading tests and surgeries which are obsolete and may have more risks.

Considerable numbers of patient go through false-positive results for breast or prostate cancer but are visibly less for lung cancer. Thus, there are fewer doubts about the optimization and utilities of lung cancer screening. Furthermore, these false-positive results can be lowered when CT scan results are discussed in a multidisciplinary team from different disciplines (including pathologist, chest physician, and oncologist)

Over-Diagnosis: Next in line of disadvantages of lung cancer screening is over-diagnosis. Over-diagnosis is a problem when a lung cancer screening test finds cases of cancer that may never have caused a problem for the patient. Over-diagnosis can lead to treatment that is not needed. Over-diagnosis is a problem with breast cancer screening too.  Unfortunately, distinguishing between the cancer traces which are to be treated and which are to be left is a tough game and this dilemma keeps some patients for an unnecessary diagnosis, unnecessary treatment, and also the emotional and physical side effects they come with.

conclusion

Lung cancer is a deadly disease and early diagnosis is a challenge. The best way to reduce the risk of lung cancer is to not smoke and to avoid secondhand smoke. Lung cancer screening is not a substitute for quitting smoking. But if you are thinking about getting screened, talk to your doctor. If lung cancer screening is right for you, your doctor can refer you to a high-quality screening facility.

The information included in this guide is not intended as a replacement for a doctor’s advice. Therefore, you should remain in close telephone/email contact with the treating physician. If you are feeling anxious, have questions, or need support, please feel free to contact me on mobile/email/whatsApp.

ABOUT THE AUTHOR

Dr Gaurav Khandelwal

M.S. M.Ch. Surgical oncology (Tata memorial Hospital Mumbai)
EBSQ European Board of Surgical Oncology Qualified
FSRS (Robotic surgery) Roswell park Cancer Centre USA
Mobile no. 8275791751
Email: drgauravkonco@gmail.com

Dr. Gaurav Khandelwal, the profound emerald completed his MBBS and MS (General surgery) from renowned MGM Medical College Indore. After post-graduation, he got selected in India’s top-tier Cancer Institute. He is the first surgeon from Indore to get admission for super-specialization in cancer treatment M.Ch. (surgical oncology) in Tata Memorial Hospital Mumbai.

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