Breathing. We do it 24-7 without even thinking about it. Our lungs are constantly bringing fresh oxygen to our bodies and getting rid of carbon dioxide. Since October was “Healthy Lung Month” and November is “Lung Cancer Awareness Month,” now is a good time to review the importance of lung health and discuss lung-cancer screening and prevention.
Why Screening is Vital
According to the Centers for Disease Control and Prevention, lung cancer is the leading cause of cancer death and the second most common cancer in both men and women in the United States. For many years, doctors did not have a good way to detect early lung cancer. This has recently changed with the introduction of high resolution computed tomography (CT) scanning, which has come a long way since its introduction in the 1970s. We can now use low-dose CT scanners to search for lung cancers in selected patients before they develop symptoms and the cancer spreads beyond the lungs.
Who Gets Screened and When?
Lung cancer screening studies have shown that high-risk patients benefit most from low-dose CT scanning. High-risk patients are those age 55 to 80 with a smoking history of at least 30 pack-years. They are either still smoking or quit within the last 15 years. How do you calculate your pack-year smoking history? Your primary-care doctor can help with the calculation, but you simply multiply your number of packs per day by the number of years you smoked. For example, smoking 1 pack per day x 30 years or smoking 2 packs per day for 15 years would get you to the 30 pack-year requirement. Current Medicare guidelines allow annual screening of patients ages 55-77, with a written order from their doctor, assuming they meet the pack-year and quitting criteria.
Lung-cancer screening with a low-dose CT scan is a useful diagnostic tool, but it’s not without downsides. There is potential for over-diagnosis of cancers that may not become clinically relevant, such as slow-growing tumors that would ultimately not cause problems during a patient’s lifetime. Patients may undergo further testing with higher-dose CT scans or even undergo biopsy or surgery, only to find that the nodule was benign, and these more invasive next steps carry additional risks. We also need to consider the impact of stress and anxiety from a nodule or suspicious finding that will be multiplied with repeat scans. Equally important, while low-dose screening uses less radiation to obtain lung images, there is some radiation exposure.
What to Expect?
A low-dose CT scan is a relatively quick and easy procedure. It requires you to lie prone on a CT scanner bed, inhale and hold your breath. The test itself is very short and should not be painful.
What is better than detecting early lung cancer? Prevention! The most important steps to prevent lung disease, including reducing lung-cancer risk, are quitting smoking and reducing secondhand smoke exposure. These steps are important at any age, including for folks in their 80s and 90s. My patients often ask, “What is the point of quitting now, I’m too old for it to make a difference?” Well, the answer is simple: you are never too old to quit smoking! Quitting at any age will improve your lung health.
Quitting smoking is not easy, of course, but there are so many tools now, including medications, to help you be successful. Your doctor can guide you in finding the right one.
Although my column focused on smoking-related lung cancer, remember that smoking contributes to other lung diseases, such as emphysema and COPD, as well as heart disease, stroke, peripheral vascular disease and other cancers. So, the next time you take a deep breath, remember how important your lungs are to your overall health.
Dr. Maija Sanna is a board-certified geriatrician with the highly regarded UCLA Geriatrics Program in Santa Monica and Westwood. For more information, visit www.uclahealth.org or call 310.319.4371.