Lung Cancer Screening Frequently Asked Questions

Cancer screening involves the use of assessments and various tests to detect cancer in its earliest stages, before any symptoms occur. When cancers are detected early, there is a greater chance that treatment will be effective, including a better likelihood of cure. Screening has been beneficial in improving early detection for lung, breast, cervical, prostate, and colon cancers.  

Lung cancer screening is the use of a radiology study to identify lung cancer before any symptoms occur. If cancer is found before symptoms occur, it allows the patient the best chance for a cure, with less treatment intensity. The type of radiology test used is called a CT scan (computed tomography), which shows images of the lungs.   

A CT scan is a diagnostic imaging test that takes multiple detailed pictures of bones, organs, and other internal tissues. It can identify abnormalities in any part of the body, including the lungs. During the lung cancer screening, the patient lies on a table and a specialized X-ray machine uses low dose radiation to make images of the patient’s lungs. The test is quick, easy, and non-invasive. It does not use contrast, needles, or any IVs. 

Age and smoking history are the greatest risk factors for lung cancer. Smoking is the leading known risk factor for and cause of lung cancer. There are also environmental factors that may put a person at risk for lung cancer. These factors include second-hand smoke and exposure to radon or asbestos. Finally, some people may be at risk based on inherited genetic risk.   

Individuals 50 years or older and who smoked the equivalent of one pack of cigarettes a day for 20 years should be screened for lung cancer. 

The best way for patients to know if they should be screened for lung cancer is to come for a personalized lung cancer screening evaluation with one of our Advanced Practice Nurse Lung Cancer Screening Coordinators. These experts will provide information so that patients can make an informed decision about having lung cancer screening. 

Lung cancer screening potentially allows for an earlier diagnosis of lung cancer, prior to the onset of symptoms—a period of time during which patients have the best chances for successful treatment and cure, with the fewest side effects from treatment. 

There are drawbacks to screening due to the possibility of findings that are not cancer, but may cause clinical concern and/or more testing. We know that people who have smoked often have abnormal findings on their screening chest CT scans. We also know that, while the vast majority of these findings are not cancers, more testing, sometimes including a 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 are low. Stated simply, we do not want patients to have any tests they do not need. On the other hand, if they do need screening, it is important for patients to feel confident that the test will be done well and for the right reason.

If patients are interested, they should contact their health care provider, who can place an order for lung cancer screening. For patients who do not have a health care provider, they can reach out to us directly. 

When a patient’s primary care provider orders a lung cancer screening CT scan, the patient will be scheduled for a brief counseling visit followed by a chest CT scan. (The counseling visit is required by most insurers.) 

During this visit, the patient will receive a detailed assessment of their personal risk for lung cancer and will have a discussion with the APRN lung cancer screening coordinator about the potential benefits and downsides of lung cancer screening. This will help the patient make a thoughtful and informed decision about having the lung cancer screening. We will answer any questions about the CT scan or about any other part of the process. 

A lung nodule is a “spot” seen on a CT scan. CT scans are very good at detecting lung nodules. The presence of lung nodules does not mean that lung cancer has been found. In fact, most lung nodules identified do not turn out to be cancer. About 25% of people undergoing lung cancer screening have nodules identified. When the nodules are found that are not suspicious for cancer, they are referred to as “incidental” findings. All nodules should be evaluated thoroughly to determine if additional testing is needed. 

Patients will meet with one of our experienced clinicians, who will review their history, perform a physical examination, and review radiology studies, followed by an in-depth discussion about the possible cause(s) of the nodule. As a team, we will determine what, if anything, should be done. Evaluating pulmonary history and any lung cancer risk factors are important parts of this evaluation.

Individuals come to the screening program because they are worried about developing lung cancer. Since screening CT frequently finds small nodules that are not cancerous more than 95% of the time, it’s important to be screened in a program with clinicians who can explain the findings and provide reassurance, or who can carefully explain the evaluation process for a nodule that is concerning.

Many lung conditions can leave temporary or permanent marks in the lungs. For example, infections can leave behind scars. Similar to scars on the skin, they are present in the lungs but do not cause any harm. Current infection or inflammation may also cause nodules. Our nodule program team will help each patient understand what the potential causes of the nodule might be and whether treatment is necessary.

We are happy to provide second opinions for lung nodules that have been evaluated at other institutions.

Smoking remains the most significant risk factor for lung cancer. Because it is better to prevent lung cancer than it is to detect it early, the most important thing one can do to prevent lung cancer is to stop smoking. Also, patients with lung who quit smoking also have better outcomes with treatment than patients who do not quit. Because it is difficult, our partners at the Tobacco Treatment Program offer a state-of-the art, personalized smoking cessation treatment program. They use the newest, most effective methods to help individuals stop smoking. 

The Yale Tobacco Treatment Program can be contacted at (203) 688-1378 or by email at quitsmoking@ynhh.org. 

While the risk accumulated by prior smoking never completely disappears, quitting does help decrease that risk. How much risk exists depends on many factors, including how many years a person smoked, how many cigarettes they smoked per day, and at what age they started to smoke. It is important to remember that there are many benefits to quitting smoking that are just as important as decreasing the risk from dying of lung cancer, including decreasing the risk of heart attack and stroke. 

Because the risk for developing lung cancer is very low for individuals who never smoked, lung cancer screening is not routinely recommended for those individuals. 

Although uncommon, individuals who have never smoked can still develop lung cancer. Patients concerned about their risk for lung cancer can have an individualized assessment with us. We will help each patient understand their risk and help make a decision about the need for lung cancer screening.

Screening does not prevent lung cancer. Screening is used to detect lung cancer earlier than would otherwise be possible. Because even after being screened patients remain at risk for developing lung cancer, we recommended rescreening at regular intervals, minimally every 10 years or as recommended by the health care team. This is also why modifying any risk to decrease personal risk, in particular, quitting smoking, is so important. 

Screening chest CT scans are done with low doses of radiation—considerably less than a regular CT scan. The risk related to the small amount of radiation from the screening test is far outweighed by the overall benefit in decreasing lung cancer deaths. However, radiation doses can add up, and so the decision to perform scans should be done thoughtfully. The quality of the radiology interpretations of the screening CT scan is important, as is the structured process for properly determining when additional scans are needed. When done in an organized approach, the risk related to radiation from screening is extremely low.

Most insurers cover lung cancer screening for individuals who qualify. Medicare covers the initial lung cancer screening counseling/decision support visit and annual low-dose Chest CT as a preventive service benefit. There should be no co-pays or deductible applied. Patients should check with their insurance carrier regarding their individual benefits.