Refuting common myths about the benefits of lung cancer screening
Lung cancer typically presents with symptoms later in the progression of the disease, leading to generally poor outcomes. Early-stage lung cancer has been traditionally difficult to diagnose for several reasons:
- Lack of symptoms: In the early stages of lung cancer, there may be no symptoms or only mild symptoms that are easily overlooked. As a result, patients may not seek medical attention until the cancer has progressed to a more advanced stage.
- Similar symptoms to other conditions: Some symptoms of early-stage lung cancer, such as coughing or shortness of breath, can also be caused by other conditions, such as asthma or pneumonia. This can make it difficult for doctors to identify lung cancer as the underlying cause.
- Lack of routine screening in the past: Unlike some other cancers, such as breast or colon cancer, there has historically been no routine screening for lung cancer. This means that many cases of lung cancer are not detected until symptoms appear or the cancer is found incidentally on imaging tests performed for other reasons.
This is now changing. Routine CT screening for lung cancer is now readily available and covered by insurance for high-risk individuals. So why is adoption lagging behind? In large part, it is because certain myths still prevail.
MYTH #1: Cost
CT screening for lung cancer is expensive and may not be covered by insurance. Doctors may be hesitant to order the test due to concerns about the financial burden it could place on patients.
REALITY: According to a study published in the Journal of the American College of Radiology in 2020, the cost of a lung cancer screening using low-dose CT (LDCT) ranged from $50 to $525, with an average cost of $137 per screening. This cost may be partially or fully covered by insurance, depending on the specific policy and the individual's eligibility. This is in contrast to the cost of a traditional CT scan of the chest with contrast, which can cost over $3,000 or more, depending on the facility, location, and complexity of the scan. This type of CT scan is typically for more complex medical issues and not screening. Thus the cost of LDCT is minimal and typically covered for high-risk individuals.
MYTH #2: Unnecessary procedures and false positives
CT screening can detect lung nodules that are not cancerous, leading to unnecessary follow-up tests and procedures. This can cause anxiety for patients and increase healthcare costs.
REALITY: It is not a false positive screen per se. All screening tests (e.g. mammography, PSA, pap smears, colonoscopy) have a process to determine what is cancer and what is not. There are well-developed algorithms for determining which nodules are cancer and which are not. What is needed is new technology to facilitate this, which is what Prana Thoracic does!
MYTH #3: Radiation exposure
CT scans use ionizing radiation, which can increase the risk of cancer over time. Doctors may be hesitant to order a CT screening for lung cancer due to concerns about exposing patients to unnecessary radiation.
REALITY: By definition, a lung cancer screening study is called a Low Dose CT (LDCT ). LDCT scans typically use about 6 times less than the radiation dose of a typical CT scan. In short, they are designed to be low radiation exposure. For this reason, LDCT screening is recommended for individuals who are at high risk of developing lung cancer, such as current or former smokers, and should be performed in accordance with established guidelines and protocols to minimize radiation exposure while maximizing the diagnostic accuracy of the scan.
MYTH #4: Limited benefit
While CT screening can detect lung cancer at an early stage, it may not necessarily lead to improved outcomes for patients. Treatment for early-stage lung cancer can be invasive and may not be appropriate for all patients.
REALITY: While that may have been the case years ago, this is hardly the case now in the era of precision medicine. Precision medicine in the treatment of lung cancer involves using genetic and molecular information to tailor treatments to the specific characteristics of a patient's cancer. The goal of precision medicine is to identify these specific alterations and develop targeted therapies that can selectively kill cancer cells while minimizing damage to healthy cells. This approach can improve the effectiveness of treatment and reduce side effects, as well as potentially improve survival rates for patients with lung cancer.
MYTH #5: Lack of evidence
Despite the potential benefits of CT screening for lung cancer, there is still limited evidence to support its routine use. Some doctors may be hesitant to order the test until more data is available on its effectiveness in improving patient outcomes.
REALITY: Several large clinical trials have been conducted to evaluate the benefits and risks of lung cancer screening using low-dose computed tomography (LDCT) in high-risk individuals. Here are some key findings from these trials:
- National Lung Screening Trial (NLST): This trial was conducted in the United States and involved over 50,000 current or former heavy smokers aged 55-74 years. Participants were randomly assigned to receive either annual LDCT screening or chest X-ray screening for three years. The trial found that LDCT screening reduced lung cancer mortality by 20% compared to chest X-ray screening.
- Dutch-Belgian Lung Cancer Screening Trial (NELSON): This trial was conducted in Europe and included over 15,000 current or former smokers aged 50-74 years. Participants were randomly assigned to receive either LDCT screening or no screening. The trial found that LDCT screening reduced lung cancer mortality by 24% compared to no screening.
- UK Lung Screening Trial (UKLS): This trial was conducted in the UK and involved over 4,000 current or former smokers aged 50-75. Participants were randomly assigned to receive either LDCT screening or no screening. The LDCT arm showed a 39% reduced risk of lung cancer mortality at 10 years compared with the control arm, and a 20% reduction of overall mortality.
Overall, the evidence from these clinical trials supports the use of LDCT screening for lung cancer in high-risk individuals, as it has been shown to reduce lung cancer mortality compared to other forms of screening or no screening.
Thus while some doctors may be reluctant to order a CT screening for lung cancer due to concerns about cost, false positives, radiation exposure, limited benefit, and lack of evidence, this is an outdated view of this subject and relies on myths vs reality. The U.S. Preventive Services Task Force (USPSTF) recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. It is important for patients to discuss the potential benefits and risks of CT screening with their doctor to make an informed decision about whether to undergo the test.
- National Lung Screening Trial (NLST), NEJM 2011
- Dutch-Belgian Lung Cancer Screening Trial (NELSON), NEJM 2020
- UK Lung Screening Trial (UKLS), The Lancet 2021