CT Scans for Lung Cancer: Lesser-Known Screening, Large Impact

Recommended for people with 30-pack-per-year history of smoking

Lung Health June 24, 2020

Blood pressure check, mammogram, colonoscopy: We hear reminders about these health screenings frequently.

CT screening for lung cancer is much less familiar, but when it comes to detecting a health issue, it is far more efficient, according to Justin Karush, DO, a Rush University Medical Center thoracic surgeon who treats patients at Rush Copley Medical Center in Aurora. In fact, looking at common exams, lung cancer screening has the greatest chance of saving a life.

“Nearly 1,200 colonoscopies need to be performed in order to save a life from colorectal cancer, and between 800 and 2,000 breast screenings, such as mammography, need be done before saving a life,” Karush says. “Only 340 screenings among the at-risk population need to be performed to save a life from lung cancer.”

One reason lung screenings have more frequent findings is a result of the current screening criteria. Using low-dose computed tomography (also called a low-dose CT scan) is recommended for a specific, at-risk population. The current guidelines for who should receive a screening are as follows:

  • Are a current smoker or a former smoker who quit in the last 15 years
  • Have a 30 pack-per-year smoking history, the equivalent of one pack of cigarettes per day for 30 years or two packs per day for 15 years
  • Are between 55 and 77 years old (for Medicare coverage) or between 55 and 80 years old (for commercial insurance coverage).

Lung cancer screening is available at Rush University Medical Center in Chicago, Rush Oak Park Hospital in Oak Park and Rush Copley Medical Center in Aurora.

As a means to complement a low-dose CT, researchers at Rush University Medical Center are working to develop a blood test for early detection of lung cancer. The researchers were awarded a grant earlier this year from the National Institutes to study this potential screening option.

Screening saves lives

Sujay Bangarulingam, MD, a board-certified pulmonologist at Rush Copley, says CT screening is simple, painless and potentially lifesaving. “Unfortunately, we are diagnosing lung cancer too often at later stages when it is inoperable,” he says. “If we can get people screened and treated earlier, we can save more lives.”

The stigma associated with lung cancer is that people brought it upon themselves by smoking says Karush. “It’s a difficult conversation to have, but an important one to have with smokers and former smokers,” he adds. “People have smoked and have done damage to their bodies, but it’s essential to get screened and catch lung cancer early when survival rates are best.”

Yet, many people who develop lung cancer don't fit the at-risk profile, like those who have never smoked. According to the American Cancer Society, as many as 20 percent of patients who die from lung cancer in the U.S. have never smoked or used any form of tobacco.

Besides those who have a history of smoking, people may be at risk to lung cancer due to the following factors:

  • Occupational exposures (asbestos, coal smoke, soot, diesel fumes, arsenic, silica)
  • Radon exposure
  • Family history of lung cancer in first degree relatives
  • History of COPD or pulmonary fibrosis

Karush says that second hand smoke doesn't have enough data currently to place someone at high risk given the variability in how much exposure someone has.

“If someone thinks they have smoked enough and is worried about lung cancer, especially if they have a family history of cancer or other risk factors, they should discuss lung screening with their physician,” says Bangarulingam.

Rush offers & honored for latest surgical techniques for lungs

When a screening detects something on a patient’s lung, Karush and other thoracic surgeons at Rush system hospitals usually can employ minimally-invasive surgical techniques, including robotic surgery, which they use to treat a wide range of conditions, including lung cancer. Using high-definition imaging technology and precision instruments, surgeons work through tiny incisions to perform these procedures, resulting in less blood loss, postoperative pain and scarring, an earlier discharge and a faster recovery time.

The Society of Thoracic Surgeons has designated the Rush University Medical Center Department of Cardiovascular and Thoracic Surgery as a three-star program for lobectomy, the most common operation performed to remove lung cancers. It is the society's highest rating and is bestowed only on the top five percent of thoracic surgery programs in the United States.

The rating is based data about outcomes of lobectomy – surgical removal of a portion of the lung – which are significantly better than national averages. This success reflects the program's expertise in video-assisted thorascopic surgery (VATS), a minimally invasive procedure that can reduce pain and recovery times compared to open chest surgery.

A patient named Gina, who had been a lifelong smoker, underwent VATS at age 75 after a CT scan detected early-stage cancer in one of her lungs. Following the surgery and chemotherapy, Gina is cancer-free, has resumed running and has stopped smoking.

“I had never heard of lung cancer screening before this, and now I tell anyone I know who smokes that they should get screened — just have it checked out,” says Gina, who tells her story in a post on Rush In Person, Rush University Medical Center’s blog. “If I hadn’t, I would not have found out I had lung cancer until it was probably too late. I feel like a lucky lady.

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