Lung Cancer Screening with CT Scans: Should You Be Having One?

Unfortunately, many American's still continue to smoke. Smoking results in a 20-fold increase in the risk of lung cancer! The smoking rate in men has declined dramatically and the lung cancer death rate in men has correspondingly decreased 1.8% each year from 1991 to 2004, the last year of data that has been printed. Recently, the smoking rate in women has begun to reduce by 13%, indicating that the risk of lung cancer in 5 to 10 years will begin to decline in women as well.

If you have been a smoker, with a 20-fold increased risk of lung cancer, or if you have been a passive smoker (living in a family with a smoker, or working around people who are smoking), with a 3-fold increase in risk of lung cancer, what can you do to reduce the risk that a fatal lung cancer may occur?

There have been many reports, beginning in Japan, and then followed up in the United States, which indicate that spiral or multi-detector CT scans can increase the chances that if a lung cancer is to occur in your lungs, it will be only a Stage I cancer, with a cure rate of over 90%, rather than a Stage II, III, or even IV lung cancer with cure rates that are only 60%, 20%, or less than 1%, respectively. Is it important, therefore, for every smoker to have an annual CT scan of the lungs?

Unfortunately, medicine does not have the complete answer to this question. CT scans of the lung can give a slight radiation exposure which might, to a small degree, increase the risks of other illnesses such as breast cancer. The physician's who favor CT scanning of the chest point out that in smokers, the risk of lung cancer is so much higher than the risk of any slight side effects of radiation that annual CT scans are absolutely needed even if there are no symptoms. Those physicians who recommend annual CT scanning point out that if you have an exposure of over 20 pack years (number of packs smoked per day x number of years that you have smoked cigarettes), then you should be requesting annual CT scans from your doctor.

Physicians who recommend against annual CT scans point out that even though CT scans unquestionably diagnose early lung cancers more effectively, there is as yet no real data that the overall risk of lung cancer deaths in all of the screened patients is reduced. National studies are underway to determine if CT scans will definitely reduce the risk of fatal lung cancer as has been suggested in the earlier studies from Japan and in the earliest studies in the United States.

However, if you have been a smoker or a past smoker, and have even the very mildest of symptoms, a CT scan is absolutely required. If you have any shortness of breath, if you have any cough, if you have any chest pain, or if you have coughed up any sign of blood or brown colored phlegm (a small amount of old blood appears brown rather than red in the phlegm), then you should ask your physician if a CT scan of the chest is appropriate. Do not neglect even the slightest symptom if you have ever been a smoker or a passive smoker.

For example, even though I have not smoked personally, my parents both smoked, and for some time I have worked among people who have smoked. I have asked my physician for CT scans which so far have fortunately been clear.

It is important to realize that the results from the initial American trials have indicated that if a lung cancer is detected by a screening CT scan of the chest, the 5-year cure rates have been over 95%. Those patients whose CT scans detected early lung cancer, but the patients decided not to have those cancers removed surgically, all died within several years. This suggests that CT scanning of the chest will find dangerous but highly curable cancer at the earliest stages of disease. Therefore, if you have been a smoker, the discussion regarding the need for a screening CT scan should be part of each of your physician office visits.

If you have been a smoker or a secondhand smoker, you must realize that the risks to your future health have been increased (for lung cancer, heart disease, lung disease, bladder cancer, blood vessel disease, pancreas cancer, mouth and throat cancer, and even breast cancer). You can control these risks by stopping smoking, avoiding second hand smoke, and by considering having a CT scan of your chest to detect disease at the earliest possible time. This is absolutely important if you have any symptoms. Even if you do not yet have any of those symptoms, still consider discussing this with your physician.