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Our Health Library information does not replace the advice of a doctor. Please be advised that this information is made available to assist our patients to learn more about their health. Our providers may not see and/or treat all topics found herein. You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them. Get the Compare Your Your Quiz Your Summary This decision aid is for people at high risk for lung cancer. This includes people age 50 and older who have a heavy smoking history and who have smoked within the last 15 years. In general, screening is more helpful for people who have smoked more and longer, because they are at the highest risk. Lung cancer starts when abnormal cells grow out of control in the lung. They can invade nearby tissues and form tumors. The cancer cells can spread, or metastasize, to the lymph nodes and other parts of the body. Most lung cancer is caused by smoking. Lung cancer screening is a way to find some lung cancers early, when a cure is more likely. Screening is done with a CT scan. It uses X-rays, or radiation, to make detailed pictures of your body. Experts recommend that these scans be done in medical centers that focus on finding and treating lung cancer. Lung screening is only recommended for people age 50 and older who are or were heavy smokers. That means people with a smoking history of at least 20 pack years. A pack year is a way to measure how much you have smoked. To figure out your pack years, multiply how many packs a day (assuming 20 cigarettes per pack) you smoke by how many years you have smoked. For example: The U.S. Preventive Services Task Force (USPSTF) recommends annual lung cancer screening if:footnote 3 The USPSTF also recommends that you no longer need lung cancer screening if you have not smoked for 15 years or if you have a serious health problem. An abnormal (positive) CT scan can be the first warning sign of lung cancer. And it means you'll need more tests. These may include more CT scans and invasive testing like a lung biopsy. In a biopsy, the doctor takes a sample of tissue from inside your lung so it can be looked at under a microscope. A biopsy is the only way to tell if you have lung cancer. If the biopsy finds cancer, you and your doctor will have to decide how or whether to treat it. The scan can suggest a problem when there is not one. This is called a false-positive result. It's common to get an abnormal result from this test even when you don't have cancer. Several things can cause an abnormal result, including small growths (nodules) that would never cause any harm. But without further tests, your doctor can't tell whether an abnormal finding is cancer, a harmless nodule, or something else. The scan may also fail to find cancer that is there. This is called a false-negative result. Your scan may also be normal (negative). A lung cancer screening test can't tell if you have lung cancer. The CT scan only shows whether there is something other than normal tissue in the lungs. Don't smoke. Most lung cancers are caused by smoking. If you have already quit smoking, you've taken the best step you can to prevent lung cancer. And if you still smoke, the best way to lower your chance of getting or dying from lung cancer is to quit. Your doctor may recommend medicines that can help you quit. Screening doesn't prevent lung cancer. It can only find some cancers early, when treatment may be more likely to work. Screening has been shown to lower the risk of dying from cancer in older people who were heavy smokers. The higher your risk (the more you smoked and the longer you smoked), the more likely it is that annual screening will prevent death from lung cancer. CT screening for lung cancer isn't perfect. It can show an abnormal result when it turns out there was not any cancer. This is called a false-positive result. This means you may need more tests to make sure you don't have cancer. These tests can be harmful and cause a lot of worry. Some lung cancers grow so slowly that they will never cause a problem and don't need treatment. You might have this type of lung cancer, but a CT scan can't tell whether it's harmless. So you may get treatment—including surgery, radiation, or chemotherapy—even though you don't need it. This is called overdiagnosis, or overtreatment. Lung cancer screening is done with a CT scan that uses a low dose of X-rays, or radiation, to make detailed pictures of your lungs. A CT scan exposes you to less radiation than most of us are exposed to each year from the natural radiation around us. But some people then need one or more follow-up scans, which use higher doses. Each time you have the screening and any needed follow-up scans will add to your total radiation exposure. Radiation from X-rays is known to cause cancer in a very small number of people. Still, for most people who are at high risk for lung cancer, the benefit of getting screened every year outweighs the risk of getting cancer from radiation. The National Lung Screening Trial (NLST) studied older people with a history of heavy smoking. The tables below show how the results of the NLST study might affect a group of 1,000 people who are at high risk for lung cancer and who choose to have yearly screening with CT scans.footnote 1 *Based on the best available evidence (evidence quality: high) The quality of the evidence about the benefits of lung cancer screening is moderate. For heavy smokers who qualify for annual screening, having this regular test offers them a better chance of not dying of lung cancer. Take two groups of 1,000 people. One group has annual screening for 3 years, and one group does not. About 6½ years later, about 18 people in the screening group and about 21 people in the non-screening group will have died of lung cancer. That means the group that did not have annual screening had 3 more lung cancer deaths than the screening group. But this is just an average. The higher your cancer risk, the more likely it is that annual screening will prevent death from lung cancer. The more pack years in your smoking history, the higher your lung cancer risk. The quality of the evidence about lung cancer screening risks is moderate. False-positive result and follow-up. A CT scan will find nodules or other problems that aren't cancer. This is called a false-positive result. This could cause you to have other tests or treatments that it turns out you didn't need, and they could cause their own problems. Take a group of 1,000 people who have annual lung cancer screening. About 365 of them will have at least one false-positive result. Of the 1,000 people tested, 25 will have an invasive procedure, such as a lung biopsy, because of a false-positive result. And 3 out of 1,000 will have a major complication because of that procedure. Major complications include collapsed lung, major bleeding, and, in rare cases, death. Overdiagnosis. Screening may find cancers that might never be life-threatening. This is called overdiagnosis. It could cause you to have treatment you don't need. And that treatment could cause its own problems. Take a group of 1,000 people who have annual lung cancer screening. Experts estimate that about 4 of them will get cancer treatment they didn't actually need. Radiation-caused cancer. There is a very small chance that the extra radiation exposure from annual lung cancer screening could cause a fatal cancer. Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it. The information shown here is based on the best available evidence. The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive. Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment will have a certain result and that 98 out of 100 will not, there's no way to know if you will be one of the 2 or one of the 98. Your doctor may offer annual screening if: Compare What is usually involved? What are the benefits? What are the risks and side effects? These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. I smoked at least a pack a day for 45 years. I know that puts me at high risk for lung cancer. Even though I've finally quit smoking, I'm going to have this test. I know there are downsides, but I want to find any lung cancer as soon as possible. Skip, age 63 I've been smoking about a half a pack a day for most of my life. My doctor talked to me about lung cancer screening and said it was an option for me. But having any kind of medical test really stresses me out. Waiting for the results makes me worry, and my doctor said that, with this test, the results can be wrong. So I'm going to skip the test and work on quitting smoking instead. Shawna, age 75 I smoked all my life. I've tried to quit lots of times. I'm still trying. But meanwhile the scary threat of lung cancer is a constant part of my life. I had my first lung cancer test last year and got an abnormal result. It turned out to be nothing, which was a huge relief. I think the worry was worth the chance of finding any lung cancer. I'm planning to do this yearly test again. Binh, age 55 My last lung cancer screening came back "positive," so my doctor recommended a biopsy to see whether or not I had lung cancer. I didn't, which is great. But that biopsy was no fun. My lung collapsed and the doctor had to insert a chest tube. I had to stay in the hospital for 3 days. I'm definitely done with annual screenings. Venturo, age 68 Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Reasons to have annual lung cancer screening. Reasons not to have annual lung cancer screening. If I have lung cancer, I want to know. I don't want to know if I have lung cancer if it hasn't caused a problem. I'm willing to have screening every year. I'm not willing to have the screening every year. I want to do everything I can to reduce my chance of dying of lung cancer. I don't want to take the risks of screening. If screening found cancer, I would get treatment for it. If screening found cancer, I would not get treatment. If there is something in my lungs, I want to know about it, even if it's not going to hurt me. If there is something in my lungs that's not going to hurt me, I don't want to know about it. My other important reasons: My other important reasons: Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. Having annual lung cancer screening NOT having annual lung cancer screening Check the facts Decide what's next Certainty 1. How sure do you feel right now about your decision? Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. This decision aid is for people at high risk for lung cancer. This includes people age 50 and older who have a heavy smoking history and who have smoked within the last 15 years. In general, screening is more helpful for people who have smoked more and longer, because they are at the highest risk. Lung cancer starts when abnormal cells grow out of control in the lung. They can invade nearby tissues and form tumors. The cancer cells can spread, or metastasize, to the lymph nodes and other parts of the body. Most lung cancer is caused by smoking. Lung cancer screening is a way to find some lung cancers early, when a cure is more likely. Screening is done with a CT scan. It uses X-rays, or radiation, to make detailed pictures of your body. Experts recommend that these scans be done in medical centers that focus on finding and treating lung cancer. Lung screening is only recommended for people age 50 and older who are or were heavy smokers. That means people with a smoking history of at least 20 pack years. A pack year is a way to measure how much you have smoked. To figure out your pack years, multiply how many packs a day (assuming 20 cigarettes per pack) you smoke by how many years you have smoked. For example: The U.S. Preventive Services Task Force (USPSTF) recommends annual lung cancer screening if:3 The USPSTF also recommends that you no longer need lung cancer screening if you have not smoked for 15 years or if you have a serious health problem. An abnormal (positive) CT scan can be the first warning sign of lung cancer. And it means you'll need more tests. These may include more CT scans and invasive testing like a lung biopsy. In a biopsy, the doctor takes a sample of tissue from inside your lung so it can be looked at under a microscope. A biopsy is the only way to tell if you have lung cancer. If the biopsy finds cancer, you and your doctor will have to decide how or whether to treat it. The scan can suggest a problem when there is not one. This is called a false-positive result. It's common to get an abnormal result from this test even when you don't have cancer. Several things can cause an abnormal result, including small growths (nodules) that would never cause any harm. But without further tests, your doctor can't tell whether an abnormal finding is cancer, a harmless nodule, or something else. The scan may also fail to find cancer that is there. This is called a false-negative result. Your scan may also be normal (negative). A lung cancer screening test can't tell if you have lung cancer. The CT scan only shows whether there is something other than normal tissue in the lungs. Don't smoke. Most lung cancers are caused by smoking. If you have already quit smoking, you've taken the best step you can to prevent lung cancer. And if you still smoke, the best way to lower your chance of getting or dying from lung cancer is to quit. Your doctor may recommend medicines that can help you quit. Screening doesn't prevent lung cancer. It can only find some cancers early, when treatment may be more likely to work. Screening has been shown to lower the risk of dying from cancer in older people who were heavy smokers. The higher your risk (the more you smoked and the longer you smoked), the more likely it is that annual screening will prevent death from lung cancer. CT screening for lung cancer isn't perfect. It can show an abnormal result when it turns out there was not any cancer. This is called a false-positive result. This means you may need more tests to make sure you don't have cancer. These tests can be harmful and cause a lot of worry. Some lung cancers grow so slowly that they will never cause a problem and don't need treatment. You might have this type of lung cancer, but a CT scan can't tell whether it's harmless. So you may get treatment—including surgery, radiation, or chemotherapy—even though you don't need it. This is called overdiagnosis, or overtreatment. Lung cancer screening is done with a CT scan that uses a low dose of X-rays, or radiation, to make detailed pictures of your lungs. A CT scan exposes you to less radiation than most of us are exposed to each year from the natural radiation around us. But some people then need one or more follow-up scans, which use higher doses. Each time you have the screening and any needed follow-up scans will add to your total radiation exposure. Radiation from X-rays is known to cause cancer in a very small number of people. Still, for most people who are at high risk for lung cancer, the benefit of getting screened every year outweighs the risk of getting cancer from radiation. The National Lung Screening Trial (NLST) studied older people with a history of heavy smoking. The tables below show how the results of the NLST study might affect a group of 1,000 people who are at high risk for lung cancer and who choose to have yearly screening with CT scans.1 *Based on the best available evidence (evidence quality: high) The quality of the evidence about the benefits of lung cancer screening is moderate. For heavy smokers who qualify for annual screening, having this regular test offers them a better chance of not dying of lung cancer. Take two groups of 1,000 people. One group has annual screening for 3 years, and one group does not. About 6½ years later, about 18 people in the screening group and about 21 people in the non-screening group will have died of lung cancer. That means the group that did not have annual screening had 3 more lung cancer deaths than the screening group. But this is just an average. The higher your cancer risk, the more likely it is that annual screening will prevent death from lung cancer. The more pack years in your smoking history, the higher your lung cancer risk. The quality of the evidence about lung cancer screening risks is moderate. False-positive result and follow-up. A CT scan will find nodules or other problems that aren't cancer. This is called a false-positive result. This could cause you to have other tests or treatments that it turns out you didn't need, and they could cause their own problems. Take a group of 1,000 people who have annual lung cancer screening. About 365 of them will have at least one false-positive result. Of the 1,000 people tested, 25 will have an invasive procedure, such as a lung biopsy, because of a false-positive result. And 3 out of 1,000 will have a major complication because of that procedure. Major complications include collapsed lung, major bleeding, and, in rare cases, death. Overdiagnosis. Screening may find cancers that might never be life-threatening. This is called overdiagnosis. It could cause you to have treatment you don't need. And that treatment could cause its own problems. Take a group of 1,000 people who have annual lung cancer screening. Experts estimate that about 4 of them will get cancer treatment they didn't actually need. Radiation-caused cancer. There is a very small chance that the extra radiation exposure from annual lung cancer screening could cause a fatal cancer. Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is—the higher its quality—the more we can trust it. The information shown here is based on the best available evidence. The evidence is rated using four quality levels: high, moderate, borderline, and inconclusive. Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment will have a certain result and that 98 out of 100 will not, there's no way to know if you will be one of the 2 or one of the 98. Your doctor may offer annual screening if: These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions. "I smoked at least a pack a day for 45 years. I know that puts me at high risk for lung cancer. Even though I've finally quit smoking, I'm going to have this test. I know there are downsides, but I want to find any lung cancer as soon as possible." — Skip, age 63 "I've been smoking about a half a pack a day for most of my life. My doctor talked to me about lung cancer screening and said it was an option for me. But having any kind of medical test really stresses me out. Waiting for the results makes me worry, and my doctor said that, with this test, the results can be wrong. So I'm going to skip the test and work on quitting smoking instead." — Shawna, age 75 "I smoked all my life. I've tried to quit lots of times. I'm still trying. But meanwhile the scary threat of lung cancer is a constant part of my life. I had my first lung cancer test last year and got an abnormal result. It turned out to be nothing, which was a huge relief. I think the worry was worth the chance of finding any lung cancer. I'm planning to do this yearly test again." — Binh, age 55 "My last lung cancer screening came back "positive," so my doctor recommended a biopsy to see whether or not I had lung cancer. I didn't, which is great. But that biopsy was no fun. My lung collapsed and the doctor had to insert a chest tube. I had to stay in the hospital for 3 days. I'm definitely done with annual screenings." — Venturo, age 68 Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements. Reasons to have annual lung cancer screening. Reasons not to have annual lung cancer screening. If I have lung cancer, I want to know. I don't want to know if I have lung cancer if it hasn't caused a problem. I'm willing to have screening every year. I'm not willing to have the screening every year. I want to do everything I can to reduce my chance of dying of lung cancer. I don't want to take the risks of screening. If screening found cancer, I would get treatment for it. If screening found cancer, I would not get treatment. If there is something in my lungs, I want to know about it, even if it's not going to hurt me. If there is something in my lungs that's not going to hurt me, I don't want to know about it. My other important reasons: My other important reasons: Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now. Having annual lung cancer screening NOT having annual lung cancer screening 1.
If I have annual lung cancer screenings, I won't die of lung cancer. 2.
An abnormal ("positive") screening test result doesn't always mean that I have cancer. 3.
The best way to lower my chance of dying from lung cancer is to stop smoking. 1.
Do you understand the options available to you? 2.
Are you clear about which benefits and side effects matter most to you? 3.
Do you have enough support and advice from others to make a choice? 1.
How sure do you feel right now about your decision? 2.
Check what you need to do before you make this decision. Current as of: October 25, 2024 Author: Ignite Healthwise, LLC Staff Clinical Review Board This information does not replace the advice of a doctor. Ignite Healthwise, LLC disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use and Privacy Policy. Learn how we develop our content. To learn more about Ignite Healthwise, LLC, visit webmdignite.com. © 2024 Ignite Healthwise, LLC.Lung Cancer: Should I Have Screening?
Lung Cancer: Should I Have Screening?
1
Facts2
Options3
Feelings4
Decision5
Yourself6
Get the facts
Your options
Key points to remember
What is lung cancer?
What is lung cancer screening?
When is lung cancer screening done?
What kind of results can lung cancer screening show?
What does lung cancer screening NOT tell you?
What can you do to prevent lung cancer?
What are the benefits of screening?
What are the risks of screening?
False-positive results
Overdiagnosis
Radiation exposure
What do the numbers tell us about the benefits and risks of lung cancer screening?
*Based on the best available evidence (evidence quality:high)Annual screening for 3 years No annual screening People who died of lung cancer within 6½ years 18 out of 1,000 21 out of 1,000 Annual screening People who got abnormal test results that proved to be wrong after more testing (false-positives) 365 out of 1,000 People who had an invasive procedure because of a false-positive result 25 out of 1,000 People who had a major complication from a procedure they had because of a false-positive result 3 out of 1,000 Estimated number of people who would get cancer treatment they didn't actually need (overdiagnosis) About 4 out of 1,000footnote 2 Benefits
Risks
Understanding the evidence
Why might your doctor offer annual screening?
Compare your options
Personal stories about considering lung cancer screening
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?
Your Summary
Your decision
Next steps
Which way you're leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
Author Ignite Healthwise, LLC Staff Clinical Review Board Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.Lung Cancer: Should I Have Screening?
1. Get the Facts
Your options
Key points to remember
What is lung cancer?
What is lung cancer screening?
When is lung cancer screening done?
What kind of results can lung cancer screening show?
What does lung cancer screening NOT tell you?
What can you do to prevent lung cancer?
What are the benefits of screening?
What are the risks of screening?
False-positive results
Overdiagnosis
Radiation exposure
What do the numbers tell us about the benefits and risks of lung cancer screening?
*Based on the best available evidence (evidence quality:high)Annual screening for 3 years No annual screening People who died of lung cancer within 6½ years 18 out of 1,000 21 out of 1,000 Annual screening People who got abnormal test results that proved to be wrong after more testing (false-positives) 365 out of 1,000 People who had an invasive procedure because of a false-positive result 25 out of 1,000 People who had a major complication from a procedure they had because of a false-positive result 3 out of 1,000 Estimated number of people who would get cancer treatment they didn't actually need (overdiagnosis) About 4 out of 1,000footnote 2 Benefits
Risks
Understanding the evidence
Why might your doctor offer annual screening?
2. Compare your options
Have an annual CT scan Don't have an annual CT scan What is usually involved? What are the benefits? What are the risks and side effects? Personal stories
Personal stories about considering lung cancer screening
3. What matters most to you?
4. Where are you leaning now?
5. What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
By Ignite Healthwise, LLC Staff Clinical Review Board Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
