Version May 2024
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LUNG CANCER SCREENING OVERVIEW — Lung cancer is the leading cause of cancer death in both men and women in the United States. The number of people who die from lung cancer each year is greater than the number of people who die from breast cancer, prostate cancer, and colorectal cancer combined. Several factors increase the risk of lung cancer, but the most important and modifiable risk factor is cigarette smoking.
This topic review discusses ways to prevent lung cancer and discusses the benefits and risks of screening for lung cancer. More information about lung cancer is available separately. (See "Patient education: Lung cancer risks, symptoms, and diagnosis (Beyond the Basics)" and "Patient education: Non-small cell lung cancer treatment; stage I to III cancer (Beyond the Basics)" and "Patient education: Non-small cell lung cancer treatment; stage IV cancer (Beyond the Basics)" and "Patient education: Small cell lung cancer treatment (Beyond the Basics)".)
PREVENTING LUNG CANCER — Cigarette smoking is responsible for almost 90 percent of cases of lung cancer; secondhand smoke exposure also increases risk. Environmental exposure to radon (a colorless and odorless gas) is an important and modifiable risk factor for lung cancer among both smokers and non-smokers. In addition, exposure to certain other substances, such as asbestos, has been linked to the development of lung cancer.
The best way to prevent lung cancer is to avoid smoking; don't start smoking, or if you already smoke, quit. Some people believe that once they have smoked for a long time, there is little point in quitting. However, studies have shown that smokers who quit decrease their risk of lung cancer when compared with those who continue to smoke. Smokers who quit for more than 15 years have an 80 to 90 percent reduction in their risk of lung cancer compared with people who continue to smoke. Quitting smoking can be challenging, but help is available, and your health care provider can support you. (See "Patient education: Quitting smoking (Beyond the Basics)".)
If you live in an area with high levels of environmental radon, it is important to test for radon in your home; you can buy a kit to test for the presence of radon in your home. If radon is present, it's important and possible to lower the level; radon treatment ("mitigation") professionals can provide guidance on the best way to do this.
If you live in the United States, you can get more information about which areas are most likely to have the potential for elevated radon levels at the following web site: https://www.epa.gov/radon/epa-map-radon-zones.
LUNG CANCER SCREENING TESTS — Researchers have studied, and continue to study, different tests for lung cancer screening.
Low-dose CT scan — A large, randomized trial (the National Lung Screening Trial [NLST]) in the United States compared the benefits of screening by low-dose computed tomography (CT) scan or standard chest X-ray in heavy smokers [1]. Compared with chest X-ray, low-dose CT scan reduced the risk of death from lung cancer by 20 percent and the overall risk of death by about 7 percent. However, nearly a quarter of the people who had yearly low-dose CT screening for three years had an abnormal test, and more than 95 percent of the abnormal tests were "false positive," meaning that they did not represent cancer. However, these people still required some sort of follow-up, usually just more imaging. Another large, randomized trial in Europe has also shown the benefit of chest CT scans for reducing lung cancer deaths among smokers and prior smokers. [2]
Yearly screening with low-dose CT scan is now recommended by many organizations for persons ages 50 to 80 years who are current or former smokers (who quit within the past 15 years) with a moderate or long smoking history. Guidelines vary among organizations regarding the specific criteria they use, including age and smoking history.
Chest X-ray — There is no evidence that having an annual chest X-ray helps extend life. In a large study comparing chest X-ray with low-dose CT for lung cancer screening, only CT showed reduced the risk of death. Current expert guidelines recommend against screening people who are at risk with chest X-ray.
Other tests — Although low-dose CT scanning is the only recommended method of lung cancer screening, experts are studying other tests that may play a future role in lung cancer screening, including sputum tests, positron emission tomography (PET scanning), bronchoscopy, breath testing, and blood tests.
IS SCREENING WORTHWHILE? — Screening is a way to detect a disease in its earliest stages, when it is more likely to be treatable or curable. For experts to recommend routine screening for any disease, it must be clear that the screening test is safe and accurate, that screening can detect the disease in the early stages, and that this can reduce the number of people who die from the disease.
Screening for lung cancer with low-dose computed tomography (CT) scan has been shown to decrease the risk of death from lung cancer in people over age 55 years who are heavy smokers or have a long history of smoking.
WHO SHOULD CONSIDER LUNG CANCER SCREENING? — Screening is only recommended for people in certain age groups with a smoking history. If all of the following statements apply to you, you may be a candidate for screening with low-dose CT scans:
●You are 50 to 80 years old
●You have smoked an amount that is equal to at least 1 pack a day for 20 years (for example, 2 packs a day for 10 years or half a pack for 40 years)
●You still smoke now or quit smoking in the past 15 years
In addition to your smoking history, you should also consider your overall health (and whether you are healthy enough to undergo treatment if screening would identify the presence of lung cancer) as well as the cost of screening. Medicare and Medicaid will pay the cost of low-dose CT screening in eligible people. However, insurance payments for screening change with time and clinical recommendations, so it is best to check with your plan regarding payment.
Benefits of screening — The main benefit of screening is that it increases the chances of detecting lung cancer early when it is generally easier to treat and may be curable. This can lower your chances of dying from lung cancer.
Drawbacks of screening — One possible drawback of screening is the risk of getting a "false positive" result. This is when a screening test finds something that looks like it might be cancer but ultimately turns out not to be cancer. False positives can occur with screening with low-dose CT scans. In addition to being stressful and possibly adding expense, this can lead to more imaging tests and/or a lung biopsy, which can be painful and can sometimes leads to problems, such as bleeding or a collapsed lung. In general, though, most false-positive findings are resolved with further imaging alone and do not require biopsy or surgery.
Some people also worry about radiation exposure. However, the low-dose CT scans used for lung cancer screening expose you to much less radiation than regular CT scans.
If you have a serious medical condition such as chronic lung, heart, or other disease, the risks of lung cancer screening may outweigh the benefits for you. If you are in generally good health, the decision to screen will depend more on your personal values and preferences. Your health care provider can help you figure out if screening is a good choice for you. The table lists some questions you can consider to help you make the decision (table 1).
WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Lung cancer screening (The Basics)
Patient education: Cancer screening (The Basics)
Patient education: Non-small cell lung cancer (The Basics)
Patient education: Lung cancer (The Basics)
Patient education: Small cell lung cancer (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Lung cancer risks, symptoms, and diagnosis (Beyond the Basics)
Patient education: Non-small cell lung cancer treatment; stage I to III cancer (Beyond the Basics)
Patient education: Non-small cell lung cancer treatment; stage IV cancer (Beyond the Basics)
Patient education: Small cell lung cancer treatment (Beyond the Basics)
Patient education: Quitting smoking (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Overview of cancer prevention
Chemoprevention of lung cancer
Cigarette smoking and other possible risk factors for lung cancer
Detection of early lung cancer: Autofluorescence bronchoscopy and investigational modalities
Overview of smoking cessation management in adults
Screening for lung cancer
Secondhand smoke exposure: Effects in adults
Females and lung cancer
The following organizations also provide reliable health information.
●The American Society of Clinical Oncology
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