The cancer screen a few know
My friend Sharon, 72, was diagnosed with two cancers. The worse one was discovered by accident.
She has an abdominal tumor that began to bother her after decades of slow growth. As part of the workup, she got a total-body CT, which showed a suspicious spot on her lung.
A biopsy confirmed it was lung cancer. Because the cancer was small and limited to one area, she underwent surgical removal. We sighed with relief.
Unfortunately, at her one-year followup, more lung nodules appeared on CT. It seems the cancer had been more extensive. Her oncologist, who has a predilection for unadorned numbers, said, “You have a 25% chance of surviving 5 years.” Sharon said, “He can’t help himself.”
Almost half of us will develop cancer in our lifetime. We have screening tests for 5 cancers. Most know the first four—cervical, prostate, colon, and breast cancer screening. But rarely do people know about the fifth – lung cancer screening.
Since 2013, the US Preventive Services Task Force (USPSTF) has recommended yearly lung cancer screening using low-dose computer tomography or CT (a fancy X-ray) for current and ex-smokers. Studies showed that screening this high-risk group might reduce the chance of dying from lung cancer by about 20%.
In 2021, USPSTF updated their guideline to be more inclusive. You’d qualify if you fulfill the following three criteria,
- You’re between the age of 50 and 80.
- And if you smoke more than 20 pack-year (e.g., smoking 3 packs a day for 10 years is 30 pack-year).
- And if you’re a current smoker or quit less than 15 years ago.
Over 8 million Americans qualify for this study. The screening test should be free under most insurance, including Medicare. (Like mammograms, there should be no copay or deductible, but check with your insurance company first.) But a recent study showed only 1 in 15 of those eligible got this screening.
I have concerns about this test. Overdiagnosis can result in unnecessary testing and procedures, expense, and anxiety. This test uses very low-dose radiation, comparable to or less than our yearly background radiation exposure, but cumulative exposure to CT scan radiation could pose a risk of developing new radiation-induced cancers. However, the chance is very, very low.
Also 10 to 20% of lung cancer occurs in non- or very-light smokers, which this screening test does not include. Please note that radon, a natural odorless gas from the soil, is the No. 1 cause of lung cancer in non-smokers according to the EPA. Test your house for radon. You can get a free radon testing kit from the Ohio Department of Health (www.ohio.radon.com) or buy the kit in hardware stores.
Sharon calls my health column the funny column; she reads and helps me on many occasions. She visits my garden when my tulips are in full bloom and piles undue praise. I cheer when she and her husband announce a getaway vacation after the chemo. I pause when she blurts, “This could be my last…” I'm there and I listen.