Lung Cancer Screening Program
Hoag Family Cancer Institute is committed to the prevention and early detection
of lung cancer. One of the best ways to prevent lung cancer is to never
start smoking, or if you are smoking – stop. Hoag offers an extensive
smoking cessation program and many resources to help individuals to stop
smoking. Learn more about Hoag's
Smoking Cessation Program.
In 2011, the National Cancer Institute released results of its National
Lung Screening Trial (NLST), which showed that low-dose CT scans reduced
mortality from lung cancer by 20 percent in patients between the ages
of 55-74, with greater than a 30 pack-year smoking history. The study,
which was conducted between 2002 and 2009, randomized 53,456 smokers or
former smokers to screening by either a traditional chest X-ray or a low-radiation
dose spiral CT scan, once a year for three consecutive years.
Learn more about the National Lung Screening Trial.
Hoag Family Cancer Institute aligns with numerous national medical societies
and organizations, and recommends annual low dose chest CT screening in
patients 55-74 years old with a history of heavy smoking (greater than
Annual screening is currently recommended for this population by the American
Cancer Society, National Comprehensive Cancer Network, American College
of Chest Physicians, American Thoracic Society, American Society of Clinical
Oncologists, American Association of Thoracic Surgeons, the American Lung
Association, and the U.S. Preventive Services Task Force.
Some of the organizations also suggest screening patients 50 years or older
with a 20 pack year* smoking history who also have an additional risk
factor such as:
- Family history of lung cancer
- Prior history of smoking related malignancy (head/neck, lung, esophageal),
- Radon exposure
- Certain occupational exposures (asbestos, arsenic, cadmium, chromium, nickel,
diesel fumes, beryllium)
- History of COPD or Pulmonary Fibrosis
The above recommendations should take into account issues such as co-existing
illnesses and life expectancy, and should be discussed with your physician.
Hoag encourages you to use this
Shared Decision-Making brochure in your conversation.
*Pack-years refers to number of packs smoked per day, multiplied by number
of years smoked.
Since 2006, Hoag has provided low-dose CT scans to detect small lung cancers
in the earliest stages when lung cancer is most treatable. Hoag’s
Lung Cancer Screening Program is recommended for both current and former
smokers, following the recommendations listed above.
Hoag's Lung Cancer Screening Program is through
physician referral only. Medicare and other insurance carriers will now reimburse the cost of
lung cancer screening for patients who meet certain criteria. This criteria
includes: being between the ages of 55-74, having smoked at least the
equivalent of one pack of cigarettes per day for 30 years. Medicare also
requires that you and your physician discuss low-dose CT scan screening,
and if it is right for you. Feel free to read through our
Shared Decision-Making brochure, to help lead the conversation.
To learn more about Hoag Lung Cancer Screening Program, please call Lung
Cancer Nurse Navigator Lilian Reed, R.N. at 949-764-6889.
Designed to meet the educational and emotional needs of lung cancer patients
and their families. The group meets the second Wednesday of each month
from 6-7:30 p.m. in Hoag Cancer Center Conference Room A.
Q: Why is the death rate from lung cancer so high?
A: Since early lung cancers usually do not exhibit symptoms, by the time
symptoms occur, the cancer has often spread (metastasized). The treatment
success for metastatic lung cancer can be limited. However, patients with
stage 1 lung cancers, or early small lung cancers, detected before spreading,
have much better survival rates.
Q: What is the difference between a chest X-ray and a low dose CT scan?
A: A chest X-ray is an X-ray picture taken of the chest, one image from
the back and one from the side. The X-rays form an image of the chest
including the lungs, but other structures like the heart and spine, may
obscure parts of the lungs where a cancer might be. Chest X-rays have
not been shown to be useful for the early detection of lung cancer.
CT imaging utilizes a doughnut-shaped camera (scanner). The CT scanner
takes several cross sectional images of the chest. CT imaging results
in a more complete picture, it's as if your body is loaf of bread, and
we're taking one slice of bread at a time and looking at the face of it,
and then we continue looking at the face of each slice through the whole loaf.
Q: Why are the CT scans called "low dose?"
A: When screening healthy smokers or former smokers for lung cancer, only
the lungs need to be viewed. As a result, the radiation administered during
the scan can be lowered to about one-sixth of what is given during a conventional CT scan.
Q: Does this new study mean that smokers do not need to stop smoking if
they get screened regularly?
A: No. The best way to prevent lung cancer is to not smoke, and if you
are currently smoking, the best thing to do is quit.
Q: If a smoker stops smoking, will that lessen his/her risk for cancer?
A: A smoker who stops smoking will significantly reduce his/her risk of
lung cancer. However, the risk of cancer will not decrease to the low
risk of someone who has never smoked.
Q: The screening is recommended for heavy smokers or former smokers, what
is considered a heavy smoker?
A: The amount someone has smoked is quantitated in pack-years. It is the
number of years someone smoked multiplied by the number of packs smoked
per day. If someone smokes one pack a day for 10 years, they have a ten
pack-year smoking history. If they smoke 2 packs a day for 10 years, they
have a 20 pack-year smoking history. There is no exact point where someone
is considered a heavy smoker. For the purposes of the National Lung Screening
Trial, a 30 pack-year smoking history was considered a heavy smoker, however,
it is best to consult with your physician on where you would be classified.
Q: What happens during the lung cancer early detection screening?
A: First, a physician referral is required. During the imaging test, you
will need to lie down on the CT table and hold your breath for about 10
- 15 seconds, while the images are taken. Your results will be provided
to your referring physician, who will review them with you during a follow-up
Many individuals will have a nodule from an old infection, or a scar,
which can be difficult to distinguish from a very early cancer. In these
cases, the patient will be referred to a pulmonologist for consultation
and will need to come back for a follow-up scan in 6 -12 months (based
on physician recommendation) to make sure the nodule isn't growing.