Lung cancer is the leading cause of cancer death in the United States. While cancer treatments have generally improved in recent years, many cancers go undetected until they’re late-stage and harder to cure.
“Lung cancer screening is about catching a potentially curable cancer in a high-risk patient before it has become symptomatic,” says Isabel Oliva, MD, chief of Yale Medicine's Thoracic Imaging in the Department of Radiology & Biomedical Imaging.
"When we find a lesion in the lungs, we always ask ourselves: 'What is the likelihood this is malignant?'" Dr. Oliva. "Most of the routine chest CT examinations done for cancer screening do not show an abnormality that requires immediate treatment, and most patients are asked to return in a year for another routine screening exam. Sometimes we find a nodule that requires close attention, so we may ask patients to return in three to six months for a follow up CT exam. Less commonly we find lesions that are more worrisome, and these patients may be referred to a pulmonologist or oncologist for further investigation."
Yale Medicine doctors support lung cancer screening for patients in high-risk groups. These include adults with no symptoms who are between 55 and 74 years old with a significant smoking history, whether or not they still smoke. We recommend people at high risk go for regular annual screenings with low-dose computerized tomography (CT).
How does lung cancer screening work at Yale Medicine?
You'll meet with a doctor to discuss the risks of lung cancer, the risks and benefits of lung cancer screening and smoking cessation—if you are still smoking. Often, you'll undergo a computerized tomography (CT) scan on the same day.
Doctors use a low-dose radiation CT scan that delivers only about one-tenth the dose of a normal chest CT scan.
“Our current goal is to decrease the dose continually until the CT scan is at a similar radiation dose as a routine chest X-ray,” says Dr. Oliva. The radiation dose is minimized because men and women in high-risk populations may have close to 25 scans over their lifetimes.
If a scan shows no sign of cancer, you'll return a year later for your next scan.
What happens after the lung cancer screening?
Radiologists will look in the CT scans for nodules—small abnormalities or spots in the lungs. Most nodules are not cancerous, but if radiologists do find nodules, they observe what they look like, how large they are and whether they are solid.
”Every so often, the radiologist encounters something unexpected like thyroid lumps, masses in the liver or coronary disease. "In our reports we address all abnormalities seen on the scan, including these incidental findings, and we provide management recommendations." Dr. Oliva says.
What’s the lung cancer screening experience like for the patient?
Yale Medicine’s doctors know that a scan is straightforward and noninvasive, but for the patient, the screening process for a serious cancer can be scary. So before the scan begins, doctors will discuss the risks and benefits of screening and explain what will happen during the scan to ease patients' apprehensions.
The conversation may continue when doctors have finished the scan and have the results. The doctors like to ensure that patients have an advocate throughout the process. “You’re treating the whole patient,” Dr. Oliva says. “Lung cancer screening is more than a CT scan.”
What's makes Yale Medicine’s approach to lung cancer screening unique?
At Yale Medicine, the comprehensive program for screening is not just about taking orders for screens and studies, Dr. Oliva says. “It’s about assessing risk factors for developing lung cancer,” she says.
The team at Yale Medicine intends to make lung cancer screening in specific populations the kind of standard practice that colon cancer screening has become. “This is a public health issue,” Dr. Oliva says. “The purpose of the program is to continuously screen these high risk patients with annual CT exams, so we can identify lung cancer early and therefore increase the likelihood of treatment response and ultimately improve patient survival."
The goal of the program is to track the imaging results of individuals and groups in order to manage future care, whether a screen comes up negative or requires further evaluation.
Yale Medicine contributes to the continued evolution of a wide-ranging, national lung cancer screening program. As reporting becomes more robust, the chance to catch lung cancer earlier will lead to better treatment options and improved prognoses.