Lung Cancer Screening: What to Expect

With SMH Pulmonologist Joseph Seaman, MD, & Radiologist Heitor Okanobo, MD

Editor's note: This blog post was originally published in December 2020 but was updated in April 2021 to reflect expanded eligibility criteria for lung cancer screening.

Mammography screens for breast cancer. Colonoscopies detect colon cancer. But did you know there’s a screening test that can find lung cancer, even before symptoms appear?

Lung cancer is the leading cause of cancer death worldwide, due in part to the fact most people don't experience symptoms until the disease has advanced and spread to other areas of the body, making it much harder to treat.

“About three-quarters of all lung cancers present with Stage 3 or Stage 4 disease, late stages for lung cancer,” explains pulmonologist Dr. Joseph Seaman, who oversees the lung cancer screening program at Sarasota Memorial’s Brian D. Jellison Cancer Institute. “Once the cancer starts to spread, the chance for a cure goes way down. But, if an individual is diagnosed with early stage lung cancer, there's a chance for a cure.”

And that’s why today’s low-dose computed tomography (LDCT) screening technology is a game-changer: LDCT scans of the chest can find lung cancer earlier, when it’s easier to treat. It’s the only proven effective way to detect lung cancer, Dr. Seaman says.  

When found in its earliest stage, lung cancer can have up to a 90% chance of cure — that means tens of thousands of lives can be saved each year.

Who Should Get Screened

People who have a high risk of developing lung cancer, but no signs or symptoms of the disease, should ask a doctor if they qualify for LDCT screening.

“Only 3% to 5% of our community is getting lung cancer screening, despite the fact that they're eligible,” Dr. Seaman lamented.

In deciding whether lung cancer screening is right for a patient, a doctor will consider the patient’s age and tobacco-smoking history — the biggest risk factors for lung cancer. Other health conditions that increase your risk of lung cancer, such as diagnosis of COPD, a family history of lung cancer or job exposure to cancer-causing agents, like radon and asbestos, can also impact your eligibility for LDCT screening. 

Most people who qualify are age 50 to 80; are current or former smokers (who quit within the last 15 years); and have a history of at least 20 years of smoking an average of 1 pack per day. 

“The more you smoke, the higher your risk for developing cancer,” says Dr. Seaman. “You’re certainly high risk at 30 pack years or more. The 20 pack-year calculation is basically smoking 1 pack a day for 20 years, or a half-pack a day for 40 years, or 2 packs a day for 10 years, and so on.”

These are the criteria that most insurance companies and Medicare use in determining whether someone's eligible for LDCT, explains Dr. Seaman. 

For individuals who meet the high-risk criteria, annual LDCT screening for lung cancer is covered by Medicare and most private insurance plans at 100%, with no out-of-pocket cost, just like mammograms and other cancer screening tests. 

What to Expect

LDCT lung cancer screening is quick and painless. It takes about 10 minutes, and the actual scan only takes a few seconds — which is important for patients who have trouble holding their breath.

It requires no needles or dye. Your clothing typically can be left in place, and there's no need to limit eating or drinking prior to the screening test. 

A machine called a CT scanner takes cross-sectional X-ray pictures of your lungs, using a small amount of radiation called low-dose CT. This level of radiation is more than a chest X-ray, but it’s 90% less than a standard chest CT scan, and no radiation remains in the patient's body afterward.

“The CT machine looks like a tube in the shape of a donut with a table in the middle,” explains SMH Radiologist Dr. Heitor Okanobo. “To start, the table will move quickly through the scanner to determine the correct starting position for the scans. Then, the table will move slowly through the machine as the actual CT scanning is performed, while you hold your breath for the short 5- to 10-second scan.” 

And that’s it. 

The images will be sent to a database, where a specialized radiologist will examine them and look for abnormalities.

Taking the First Step

If you are smoker, ex-smoker or have other risk factors for lung cancer, ask your doctor whether LDCT screening is right for you. 

Your physician can refer you to an experienced lung cancer screening program. The facility should have a low-dose CT machine and a team of specialists (pulmonologist, radiologist, oncologist, pathologist, thoracic surgeons, and trained technologists and nurses) that can provide the appropriate care, analysis and follow-up for patients with abnormal LDCT results.

“We want to get the message out that there are things we can do to help people with risk factors for lung cancer,” Dr. Seaman explains. “We can help them identify their risk level, and we can screen the appropriate patients so that we know who may have lung cancer. Then we can aggressively manage their nodules and cancer.”

“But it all starts with the patient and the patient's friends or family, who can encourage them to go get screened for lung cancer.”

Call 941-917-5864 or email lungcancerscreening@smh.com to learn more.