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Lung cancer has been the leading cause of cancer death in the United States for many years. One in five cancer deaths in this country is due to this type of cancer. In fact, more Americans die from lung cancer than from breast, prostate and colon cancer combined.
The American Cancer Society (ACS) estimates that about 125,000 Americans will die from lung cancer this year and about 60,000 of those people will be women.
Smoking is the leading cause of lung cancer, and the ACS estimates that tobacco causes about 8 out of 10 cases of lung cancer.
But there is also good news. The number of new cases of lung cancer has fallen by an average of 2.4% each year, according to the latest statistics. And death rates have fallen by an average of 4.2% each year over the past decade.
Anti-smoking initiatives have helped many Americans quit smoking or, better yet, never start. And lung cancer treatments have become much more effective over time.
Another factor that has contributed to these improvements: lung cancer screening for people at high risk. Researchers estimate that lung cancer screening could reduce the disease’s mortality rate by up to 20%.
Here are some answers to frequently asked questions about lung cancer testing.
What are lung cancer tests?
Generally, healthcare providers use screening tests for the disease in healthy people who have no symptoms. The goal of the testing is to detect the disease in its early stages, when treatment is most likely to be effective.
Lung cancer testing involves performing low-dose computed tomography (LDCT) of the lungs to detect lung cancer. This test is currently only recommended for people who are at high risk of developing lung cancer.
To perform this quick, painless test, you lie on a platform that moves over a CT scanner to get clear images of your lungs.
Read: Symptoms of Lung Cancer >>
Who should undergo these tests?
The US Preventive Services Task Force (USPSTF), a group that reviews scientific evidence to make recommendations for patient care, has released its latest recommendations in 2021. Lung cancer testing is recommended for people who meet these requirements:
- Be between 50 and 80 years old
- You must have smoked for at least 20 pack-years (the number of packs of cigarettes you smoked daily multiplied by the number of years you smoked).
- Smoke or have stopped smoking in the last 15 years.
Compared to previous versions, the current USPSTF guidelines lowered the testing start age from 55 to 50 and the minimum pack-years from 30 to 20.
These changes significantly increased the number of women, particularly black women, who are at high risk of lung cancer.
The ACS also has a lung cancer testing policy. There’s one important difference from the USPSTF guideline: The ACS recommends annual testing, regardless of how long you’ve quit smoking.
What is a “pack year”?
Scientists who study tobacco use use the term “pack-year” to assess how much people have smoked over time. Multiply the number of packs of cigarettes you smoked per day by the number of years you smoked. This is your packing year.
If you smoked two packs a day for 10 years, that’s 20 pack-years, which means you’re eligible for a lung cancer test. If you smoked a pack a day for 15 years, that’s 15 pack-years, which is below the testing threshold of 20 pack-years.
Why can’t we test everyone for lung cancer, even people who aren’t at high risk?
All screening tests have potential benefits and risks. Therefore, you and your doctor should discuss your personal history and whether you should be tested for lung cancer. Making decisions together requires you to review this information and create a plan for your care together.
It is important to note that smoking is currently the only lung cancer risk factor considered in screening guidelines.
Other possible causes of lung cancer such as air pollution, radon exposure, secondhand smoke and genetic mutations are not considered in the current guidelines. Scientists are studying whether personalized screening methods could identify more cases of lung cancer and potentially save more lives.
Read: How shared decision-making can promote better healthcare >>
What are the benefits of a lung cancer test?
The main advantage of lung cancer testing is the ability to prevent death by detecting this disease as early as possible.
La American Lung Association [Asociación estadounidense del pulmón] (ALA) reports that lung cancer screening detects more than half of lung cancer cases at an early stage, when it is most treatable.
One study found that only about one in four cases of early-stage lung cancer were detected without testing.
What are the risks of a lung cancer examination?
Lung cancer tests are unlikely to miss cancer if it is present, but it can happen. This is called a false negative result.
Test results that suggest a person has cancer when they don’t are called false positives. The ALA estimates that about 12 to 14 percent of early lung cancer tests produce false positive results. But only about 6% of repeat tests show false positives because health care providers run multiple tests over time to detect changes.
A potential downside to lung cancer testing is that it may also identify cancers that would never have caused harm without intervention. In rare cases, lung cancer spreads slowly and without symptoms. But any type of lung cancer diagnosis means your doctor will likely recommend treatment. And treating a cancer that is not allowed to cause harm is considered unnecessary treatment.
TCBD testing also uses low-dose radiation to obtain images of your body. Over time, this radiation can cause medical problems. However, it is important to know that BDCTs use much less radiation than traditional CT scans.
What are some of the barriers to lung cancer testing?
According to the State of Lung Cancer report. [Situación del cáncer pulmonar] According to the ALA, only 16% of eligible people were tested for lung cancer in 2022.
In practice, various barriers could prevent eligible individuals from undergoing lung cancer testing. For example, some people at high risk may not know that they are eligible for a lung cancer test.
People who have smoked or have smoked for a long time may refuse these tests because they fear developing lung cancer or because they fear that people with lung cancer will be stigmatized as if it was somehow their fault.
Problems with transportation and physical access to TCBD testing centers can also result in people not being tested. This is particularly true for people living in rural communities.
If you are eligible for a lung cancer test, cost may not be a barrier. Medicare and most private insurance plans cover 100% of lung cancer testing for eligible individuals. This means that, like mammograms and other screening tests, you are unlikely to incur unreimbursed costs. However, additional tests or follow-up visits between screening tests may incur costs, such as co-payments or deductibles.
This educational resource was created with support from Merck.
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