Lung Cancer Screening

Dr. Williams: Well, similar to all screening tests, the recommendation for lung cancer screening was made after extensive research. So the research that was conducted was a national study. What the scientists wanted to learn was, for individuals with high risk for lung cancer, what was the best screening test? Was it chest X-ray or was it a low dose CAT scan? So the individuals in the study were randomized to receive either a chest X-ray or a low dose CAT scan. At the end of the research, it was discovered that those individuals who had the low dose cat scan, their lung cancer was diagnosed earlier and, later on, their death rate was lower than the people who had chest X Rays. So then the recommendation was made that low dose CAT scans would be the screening test for lung cancer.

Dr. Williams: Yes, it's a very simple test. It's a done once a year. The individual undergoes a low dose cat scan. They lay on a table, no IV is required, they hold their breath for about 5 to 7 seconds, and then they run through the scanner and the test is over. 

Dr. Williams: Well, in order to meet the screening criteria for a lung cancer test, an individual should have a history of heavy smoking. This is defined as a pack a day for 30 years, or it could be 2 packs a day for 15 years, or have quit smoking within the last 15 years. They must also be between the ages of 55 and 80 years old. 

Dr. Williams: Unfortunately, the uptake of lung cancer screening is only about 5%, so that's very low. 

Dr. Williams: Well, other screening tests, such as breast cancer screening, those screening tests the uptake might be 85 or 90%. 

Chloe: So it's very different.

Dr. Williams: Absolutely, there are some barriers to lung cancer screening. Number one, as we discussed, people don't know about lung cancer screening. It's our newest screening tests so there's a lack of awareness. That's one barrier. Other screening tests such as breast cancer and colon cancer, people are very familiar with those tests, whether they meet the criteria for those tests or not they know about them. But not as much with lung cancer screening. Additionally, it's very hard to determine how much a person has smoked. In order to be screened for lung cancer, the person must have smoked a pack a day for 30 years. Most people who use tobacco don't use a certain amount of tobacco consistently. There may be times that they smoke a pack a day for several years and then they might lower to a few cigarettes a day, perhaps if they have a new child in the home, or in the case of a woman if she's pregnant. So it's very hard to determine who's at risk and who should be screened. Additionally, unlike other screening tests, with lung cancer screening tests, the clinician who orders that test must have a shared decision-making conversation with the person. In that conversation, they have to describe the risks as well as the benefits for lung cancer screening. What that means is, that requires a visit to the provider to have that shared decision-making conversation. So they can't be screened, perhaps, at a health fair, as they could be screened for perhaps, diabetes. So that's another barrier to lung cancer screening.

Chloe: That's a lot of barriers.

Dr. Williams: Absolutely. We're very excited about lung cancer screening because we believe that it can change the face of lung cancer. Historically, individuals with lung cancer were more likely to be diagnosed at a very late stage and that's why lung cancer has such a high death toll. In fact, it's the biggest cancer killer. So we're hoping that with lung cancer screening, as more high risk people are screened, that we will identify lung cancer much earlier and that people's outcomes will improve. We know that early detection does change outcomes more positively. 

Chloe: Well, thank you so much for your insight and your time Dr. Williams.