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Lung Screening and Nodule Program FAQ

1. Why do we screen for cancers?

Screening allows us to detect cancers before they cause symptoms. When cancers are detected early, there is a greater chance that treatment will be effective. The goal of cancer screening is to reduce the risk of dying from cancer. Screening has been beneficial in improving early detection for breast, cervical, prostate, and colon cancers, and now is available for lung cancer.

2. Why are we just starting to screen for lung cancer?

Screening for lung cancer is based on years of clinical research and the results from the National Lung Cancer Screening Trial (NLST) which have recently been released. The NLST is a very large landmark study that was sponsored by the National Cancer Institute. The 53,000 people who participated in this study were between the ages of 55 and 74, and had smoking history equivalent to at least 1 pack of cigarettes per day for 30 years.  Current smokers or individuals who had quit within the past 15 years were eligible to participate.  The NLST demonstrated that annual screening for 3 years with low-dose CT scanning under the guidance of a dedicated comprehensive lung cancer screening program resulted in a 20% decrease in deaths related to lung cancer. Screening CT detected less advanced stage lung cancers -in other words, screening resulted in early detection and prevented 1 in 5 deaths from lung cancer.

3. Why should you get screened through the Yale Lung Screening and Nodule Program?

A well organized, integrated screening program is critical to ensuring optimal benefit. The Yale Lung Screening and Nodule Program is a comprehensive program, involving a multidisciplinary team of internationally recognized pulmonologists, chest radiologists, thoracic surgeons, thoracic oncologists, smoking cessation specialists, and nurse practitioners whose primary goal is to provide patients who are at risk for developing lung cancer with individualized screening evaluation. Our program includes:

▪ Personalized lung cancer risk evaluation and clinical assessment

▪ Detailed discussion of individual benefits and downsides of lung cancer screening

▪ Smoking cessation counseling and treatment for active smokers

▪ Low dose screening CT scan or other tests, based on the clinical assessment

▪ CT scan review and interpretation by a dedicated and experienced team

▪ Management recommendations of any findings from our expert panel

▪ Continuity of care and ongoing monitoring

4. Should I be screened for lung cancer?

Benefits related to lung cancer screening have been clearly proven for the following people:

  • Healthy adults ages 55-74 years, who are current smokers with the equivalent of at least 1 package of cigarettes/day for 30 years, or who are former smokers with the equivalent of at least 1 package of cigarettes/day for 30 years and who have quit within the past 15 years

For individuals who do not fit these criteria, but have other risk factors for developing lung cancer, Yale Lung SCAN has developed an organized process to evaluate you. This assures that decisions are made in a thoughtful, informed way that maximizes the benefits and minimizes the potential negative effects of screening.

5. Why is smoking cessation included in our program?

Preventing lung cancer is better than finding it early. Smoking is the most important risk factor for lung cancer, one that can be modified. Quitting smoking is very difficult, and the success rate is much better with the right help. The Yale Smoking Cessation Program uses a highly sophisticated and evidenced based approach that will help you quit in a way suited to work best for you.

You can contact the Smoking Cessation Service at (203) 688-1378 or by email at quitsmoking@ynhh.org.

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6. What happens when you come to the Yale Lung Screening and Nodule Program?

First, a detailed assessment of your risk for developing lung cancer will be performed, as well as an explanation of how the benefits and downsides of lung screening stack up for you. This will allow you and the Yale Lung SCAN team make an informed decision as to whether or not you should get a screening chest CT scan. This will ensure that the decision is sound, based on the best data available. Decisions should not be made based on fear or anxiety, but on facts. A thoughtful and informed decision should allow you to feel confident in your medical care. If there are ways to modify your risk of lung cancer, we will help you initiate this. If you proceed with a screening chest CT scan, we will explain the process and ongoing surveillance. Small abnormalities are common findings on screening chest CT scans. The vast majority of these are benign, meaning they are NOT cancer.

If a nodule is found on your scan, it will be evaluated by our experienced clinical team. We will explain to you what to make of it so that you are sure that the decision is made thoughtfully whether it is nothing or something that needs to be looked at more carefully. Yale Lung SCAN will continue to look out for you. Screening is not a one-time event, but on the other hand you should not have frequent scans that are not necessary. Yale Lung SCAN will arrange further screening when appropriate and will incorporate any new tests that have been shown to be helpful for individuals like you.

7. Am I at risk of developing lung cancer?

Smoking is by far the strongest risk factor for developing lung cancer, but there are many other risk factors. Hereditary factors are important (i.e. having a close relative who has had lung cancer). Occupational or domestic exposures to carcinogens such as asbestos or radon contribute to risk.

The presence of lung problems such as COPD or interstitial lung disease also increases risk. Exposure to second hand smoke also has an effect, although it is small. A number of other factors may also contribute to lung cancer risk. The decision of whether or not it is likely you will benefit from being screened should take all your individual factors into consideration, and this process is an important and integral part of the Yale Lung SCAN evaluation.

8. If I quit smoking, am I still at risk for developing lung cancer?

The risk you have accumulated by smoking never disappears. However, quitting will help decrease your risk. How much risk you have depends on many factors such as how many years you smoked, how many cigarettes you smoked per day, and at what age you started to smoke. It is important to remember that there are many benefits to quitting smoking that are just as important as decreasing your risk from dying of lung cancer.

9. If I have never smoked, what is my risk for developing lung cancer?

Screening chest CT is not recommended in individuals who have never smoked because in general their risk of developing lung cancer is very low. It is important to know that there are many other risk factors for developing lung cancer besides smoking, and individuals who have never smoked can still develop lung cancer. This is an area where more research needs to be done. Yale Lung SCAN can offer you an individualized assessment of your risk to guide you in making the right decision about whether to undergo a screening chest CT scan.

10. What are the benefits to screening?

Lung cancer screening can reduce your risk of dying from lung cancer. Screening certain people who are at an elevated risk of developing lung cancer with screening CT scans can prevent 1 in 5 deaths from lung cancer. CT scanning allows us to detect small lung abnormalities that a normal chest x-ray cannot identify. If you are screened and are found to have lung cancer, it is more likely it will be at an early stage and less likely to be at an advanced stage.

11. If I get screened, can I be sure I will not get lung cancer?

Screening does not do anything to change your likelihood of developing lung cancer; its only purpose is to detect lung cancer earlier than would otherwise be possible. That is why risk modification is an important component of a screening program. It is also why you cannot be screened once or twice and then stop. How long and how often you should be screened is an area that is continuing to evolve.

12. Are there downsides to screening for lung cancer?

There are drawbacks to screening due to the possibility of misleading findings. We know that abnormal findings are common on screening chest CT scans, but that the vast majority of these findings are not cancers. However, sometimes extra tests including biopsy or surgical removal may be required in order to determine whether the finding is cancer or not. When these tests are ordered and used appropriately and in the right setting by experienced clinicians, the risks of additional testing is low. Stated simply, you do not want to have any tests that you do not need; on the other hand if you do need them you want to be confident that they will be done well and for the right reason.

13. Should I be worried about radiation exposure?

Screening chest CT scans are done with low doses of radiation, considerably less than a regular CT scan. In the right population, the risk related to the small amount of radiation from the scan is outweighed by the overall benefit in preventing lung cancer death. However, radiation dose can add up, and so the decision to perform scans should be done thoughtfully. The quality of a screening CT scan interpretation is important, as well as a structured process for properly determining when additional scans are needed and when they are not. When done in an organized approach, the risk related to radiation from screening is extremely low.

14. I am very anxious about a possible lung cancer, what do I do?

Individuals come to the screening program because they are worried about developing lung cancer. Since screening CT frequently finds little nodules that are NOT cancers >95% of the time, you want to be screened in a program that carefully sorts out the nodules that are nothing from the nodules that are something to worry about. Being in a program with clinicians who can explain the findings to you and give you reassurance that a nodule is nothing, or who can take you carefully through an evaluation for a nodule that is something to worry about, is very important.

15. What if I get screened and an abnormality is found?

Screening CT is so sensitive that it detects small lung abnormalities in approximately 25% of people undergoing screening. The vast majority of these (>95%) are NOT cancer. Proper interpretation of the scan is extremely important. You do not want to worry unnecessarily about a nodule that is nothing; on the other hand a potentially concerning abnormality, no matter how small, warrants appropriate attention.

16. I have had a CT scan that shows a nodule, what do I do?

If you have had a CT scan at another facility, and have questions about its results, we are prepared to help you. We have developed a component of our program, the Nodule Program, specifically for this situation, because it happens so commonly. We will need to meet you, evaluate your risks, and review your scan with our expert team. We can explain what we think the nodule is and what (if anything) should be done about it.

17. Are all lung cancers dangerous?

Many lung cancers are diagnosed at advanced stages, and can be debilitating or fatal. However, some lung cancers do not grow for years and years, or change very slowly. The Yale Thoracic Oncology Program has many years of experience and has been at the forefront of defining how lung cancers should be approached. Lung cancer care should be individualized, evidence-based, and comprehensive to ensure that patients receive the best care possible, to achieve the best longevity and quality of life possible. 

18. Is lung screening covered by insurance?

Some insurance companies cover for screening. However others, including Medicare, do not. How screening should be implemented in the United States health care system is currently being defined. Until this occurs, insurance coverage will be partial. Therefore, costs of the screening process may be an out-of-pocket expense.

19. I saw an advertisement for low cost lung cancer screening. What are the differences between this and the Yale Lung Screening and Nodule Program?

Getting a chest CT scan by itself for lung cancer screening is like buying an engine mounted on wheels instead of a car, without steering or brakes. Screening should be an evaluative process, not just a test. Ideally, screening should be performed within a structured program with all the components integrated into a well-functioning unit, in order to be most efficient and effective.

20. Screening for breast cancer with mammography is easy, why is lung cancer screening so much more of a process?

CT screening for lung cancer is just beginning to be implemented outside of a research setting, whereas breast cancer screening has been around for decades. There are many differences between conditions that affect the breast and the lungs. The process of breast cancer screening has undergone a long evolution and is governed by national quality standards. The quality standards for lung cancer screening are just being developed. This is why it is important to be screened through a structured, evidence-based, comprehensive lung cancer screening program that uses a well-designed screening process.

If you interested in more information, or want to schedule a consultationplease call us at 203-200-LUNG (5864).

Additional Resources:

National Cancer Institute

Lung Cancer Screening (PDQ):

http://www.cancer.gov/cancertopics/pdq/screening/lung/Patient

Lung Cancer Prevention (PDQ): 

http://www.cancer.gov/cancertopics/pdq/prevention/lung/Patient

National Lung Screening Trial:

http://www.cancer.gov/clinicaltrials/noteworthy-trials/nlsthttp://www.cancer.gov/newscenter/qa/2002/nlstqaQA