Dr. Jacqueline Gerhart: Getting Screened For Lung Cancer
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that usually appears weekly on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: I am a 38-year-old and I smoke. Should I get screened for lung cancer?
Dear Reader: Great question. I've recently written on breast cancer and prostate cancer screening. Discussing screening and diagnosis of lung cancer is very important as well.
Lung cancer is the second-leading cause of death in the U.S., behind heart disease. Lung cancer kills more than breast, colon and prostate cancers combined, and it is the leading cause of death from all types of cancer worldwide. More than 85 percent of lung cancer patients die from the disease, making lung cancer one of the most lethal cancers. Lung cancer is highly associated with smoking. However, about one in five women and one in 12 men diagnosed with lung cancer have never smoked.
Most lung cancers are first diagnosed based on symptoms. The symptoms often start slowly and progress over time (often months to years). As you can expect, the symptoms related to lung cancer are those that reflect the inability of the lung tissue to function. Symptoms include: worsening cough, chest discomfort, shortness of breath, and spitting up blood. Some patients also have unexplained weight loss, back pain, loss of appetite, night sweats and general fatigue.
Unlike mammography for breast cancer, or colonoscopy for colon cancer there is not a widely accepted screening tool for early-stage lung cancer. Chest X-rays are usually not sensitive or reliable enough to find lung tumors at the earliest stages. In fact, when a very small spot on a chest X-ray is found, we almost always follow up that chest X-ray with a CT scan of the chest to better characterize that spot. Once a spot is found on a imaging study, we often will do follow-up imaging in a few months to one year to re-evaluate the spot if it looks concerning. If there are characteristics that are particular to cancer – such as large size, or irregularity, then you likely will be sent for further evaluation to a lung doctor (pulmonologist).
There have been some studies and groups - including the American Society of Clinical Oncologists - who have recommended routine chest CT exams in high-risk patients. "High-risk" patients include those between age 55 and 74, who have smoked for at least 30 years, and who have quit less than 15 years ago.
So, in answer to your question, since you are only 38 years old, you do not fall into this age category. And, even if you did, we would first have a discussion about the benefits and risks of CT scan for your individual case and a discussion of any symptoms you may have. Similar to prostate cancer screening, there are downfalls to lung cancer screening. First, a CT has more radiation than an X-ray. And excess exposure to radiation over time could lead to more harm than benefit.
Bottom line: If you are a smoker, be honest with your doctor about how much you smoke. This will help your physician determine the best course of care for you - which will start with ways to help you cut down or quit!
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 05/06/2014