Lung Cancer Screening: Who Qualifies for a Yearly Low-Dose CT Scan

Finn: There are trade-offs. Many scans find spots that turn out not to be cancer. These are called false positives. In that same trial, about 1 in 4 people had a false positive at the first scan.

Claire: One in 4. That's a lot of people getting scared by a spot.

Claire: Thanks for joining us. You're listening to Between Visits, sponsored by Hope Health Network, a network of medical practices serving South Carolina. We dig into the medical and mental health topics that matter most to patients and the public.

Claire: I'm Claire, and this is episode 7. I'm going to quickly play our disclaimers, and then we'll get started!

Recorded disclaimer: This show is for entertainment, education and general information only. It's not medical advice, and listening doesn't make you a patient. Our hosts and guests are not real people, medical doctors or healthcare providers. We do our best, but we can be wrong, and our content can have errors and omissions. Talk with a licensed medical provider in your state before you make any decisions about your health or medical care.

Claire: In an emergency, call 911. In a crisis, call or text 988.

Claire: Joining me today is Finn, from our digital entertainment team. Welcome, Finn!

Finn: Happy to be here, Claire. Is that a new coffee mug?

Claire: It is. It holds about twice what the old one did.

Finn: So that's the secret to all this energy.

Claire: Today we're talking about Lung Cancer Screening: Who Qualifies for a Yearly Low-Dose CT Scan. Well, we're excited to get your thoughts on this important topic, Finn.

Claire: Let's dig into lung cancer screening. That word, screening, can make people nervous. So what are we actually talking about here?

Finn: We're talking about one scan, once a year. It's called a low-dose C T. If you smoke now, or you quit in the last 15 years, it may help find lung cancer early, when the outlook is better.

Claire: And low-dose means what, exactly?

Finn: It means the scan uses a small amount of radiation. We'll come back to that.

Claire: Okay. So is this for anyone who ever smoked? Or who are we talking about?

Finn: The U.S. Preventive Services Task Force is a national panel of medical experts. It recommends this yearly scan for adults who meet all three of these things.

Claire: All three. Okay, go ahead.

Finn: First, you're age 50 to 80. Second, you have a smoking history of at least 20 pack-years. Third, you smoke now, or you quit within the past 15 years.

Claire: And how strong is that recommendation?

Finn: The panel published it in March 2021 with a grade B. The grade shows how strongly the panel recommends it. And this is for people with no symptoms of lung cancer.

Claire: So if someone does have symptoms, this isn't the path?

Finn: Right. Screening is for people with no symptoms. If you have symptoms, talk with your provider.

Claire: Now, you said pack-years. I don't think most people know their pack-years. What is that?

Finn: It measures how much you've smoked over time. You take packs a day, times years smoked. One pack is 20 cigarettes.

Claire: Give me an example, because I need to see it.

Finn: Sure. One pack a day for 20 years is 20 pack-years. Two packs a day for 10 years is also 20 pack-years.

Claire: So those two people are the same on paper, even though one smoked for half as long.

Finn: Right. Now here's one that falls short. Half a pack a day for 30 years is 15 pack-years. That's below the 20 the recommendation uses.

Claire: Thirty years, and it's still under. That surprises me. But real life is messier, right? Some years you smoke more, some years less.

Finn: It is messier. If your smoking changed over the years, your provider can help you add it up.

Claire: That's good. Nobody needs to sit at home with a calculator. Has this always been the rule? Because someone may have been told years ago they didn't qualify.

Finn: It's a good question. In 2021, the panel lowered the starting age from 55 to 50. It also lowered the smoking history from 30 to 20 pack-years. So more people now qualify.

Claire: So if you were told no a while back, it may be worth asking again.

Finn: Yes. Bring it up at your next visit.

Claire: Does screening ever stop? Do you just keep going every year?

Finn: The panel says to stop once you've gone 15 years without smoking. Screening also stops if another health problem greatly shortens your expected lifespan.

Claire: Is that it?

Finn: There's one more. It stops if you could not have, or would not want, lung surgery to treat a cancer.

Claire: Okay. Let's talk about whether it actually works. Does this scan save lives?

Finn: In large studies the panel reviewed, low-dose C T screening lowered deaths from lung cancer. In the National Lung Screening Trial, the drop was 16 percent with longer follow-up.

Claire: So 16 out of every 100 people are saved?

Finn: No, and it's easy to mix that up. It's what's called a relative reduction. The risk of dying from lung cancer was 16 percent lower than in the comparison group. It does not mean 16 out of every 100 people.

Claire: Okay. So it's lower compared to the other group, not 16 people out of 100. Why does finding it early matter so much?

Finn: Early-stage lung cancer has a better outlook than cancer found later.

Claire: That all sounds pretty good. So what's the catch? There's usually a catch.

Finn: There are trade-offs. Many scans find spots that turn out not to be cancer. These are called false positives. In that same trial, about 1 in 4 people had a false positive at the first scan.

Claire: One in 4. That's a lot of people getting scared by a spot.

Finn: It can be scary. So it helps to know that ahead of time. Checking a spot can lead to more tests, and sometimes a biopsy or surgery. A biopsy means taking a small piece of tissue to test it. Complications are uncommon.

Claire: So if I get a call about a spot, that doesn't automatically mean cancer.

Finn: Right. Many spots turn out not to be cancer. Your provider can go over the results and the next steps with you.

Claire: Are there other downsides?

Finn: Yes. Screening can find cancers that would never have caused harm. That's called overdiagnosis.

Claire: And the radiation? You said we'd come back to that. People do worry about it.

Finn: They do. A low-dose C T uses about 0.65 to 2.36 millisieverts. That's a unit of radiation dose. People in the U.S. get roughly 2.4 from natural background radiation each year.

Claire: So the scan is less than one year of that background amount.

Finn: Right. And all of this is why the panel says you and your provider should talk through the benefits, limits and harms before you start.

Claire: So it's a conversation first, not just a scan. Okay, let's talk about money. Will insurance pay for this?

Finn: HealthCare dot gov has a list of preventive services. Lung cancer screening for adults 50 to 80 at high risk is on it. Marketplace plans and many other plans must cover those services without a copay from an in-network provider, even before you meet your deductible.

Claire: So it's free, then.

Finn: Not so fast. HealthCare dot gov notes that zero cost is not guaranteed in every case. So check with your plan.

Claire: Okay, check with your plan. And what about Medicare?

Finn: Medicare Part B covers a yearly low-dose C T for people 50 to 77. They must have no symptoms, at least 20 pack-years, and smoke now or have quit within the last 15 years.

Claire: Hold on. The panel said up to 80, and now you're saying 77.

Finn: Good catch. Those are two different things. The panel's recommendation goes to age 80. Medicare Part B's rule for this scan goes to 77.

Claire: So if you're in that gap, ask questions. Does Medicare need anything else?

Finn: Yes. Medicare requires a visit before your first scan, to talk through the benefits, limits and harms. And your provider must order it.

Claire: Now, here's something I want to push on. If I'm getting a scan every year, couldn't someone say, well, I'm being watched, so I can keep smoking?

Finn: That's a really fair thing to bring up. But the panel says screening does not prevent most lung cancer deaths. So quitting is still essential.

Claire: So the scan can find a problem, but it doesn't take the place of quitting.

Finn: Exactly. And you don't have to do it alone. The American Cancer Society says counseling and medicine can double or even triple your chances of quitting.

Claire: Double or triple. That's worth knowing, especially for someone who has tried before. What kinds of medicine?

Finn: Varenicline, bupropion and nicotine replacement are ones to ask about. Your provider can talk through how they compare.

Claire: And is there help if money is tight?

Finn: Yes. The South Carolina Department of Public Health says its S C Tobacco Quitline offers free quit support, 24 hours a day, 7 days a week, whatever your insurance.

Claire: How do people reach it?

Finn: Call 1-800-QUIT-NOW. Or text the word READY to 3 4 1 9 1. You can also visit quit now s c dot org.

Claire: And there's a date coming up that could be a good start, right?

Finn: There is. The Great American Smokeout is Thursday, November 19. It's a good day to check whether you qualify and to start a quit plan.

Claire: I like that. Make it day one. If someone's listening and they're not sure how to bring this up, what could they ask?

Finn: Here's a simple one. Based on my smoking history, do I qualify for a yearly low-dose C T scan?

Claire: That's easy enough. You could say that at any checkup.

Finn: You could.

Claire: Okay, before we wrap up. If people only remember a few things from today, what should they be?

Finn: First, know your three checks. Age 50 to 80. At least 20 pack-years. And you smoke now, or you quit within the past 15 years.

Claire: Okay. What else?

Finn: Second, screening has trade-offs. Many spots turn out not to be cancer. So talk through the benefits and harms with your provider before you start.

Claire: And one more?

Finn: Screening does not replace quitting. And there's help for that, including the free quitline at 1-800-QUIT-NOW.

Claire: That's really helpful. Thank you for walking us through this.

Finn: Thanks for having me, Claire. I hope it helps someone.

Claire: This episode is sponsored by Hope Health Network. Its member practices all have providers experienced in lung cancer screening, or can refer you to a network provider who is. Hope Health Network medical practices provide evidence-based medical care and include Hope Integrative Medicine, Hope Medical Associates, Hope Behavioral Medicine and Hope Addiction Medicine. To learn more, go to Hope Health Network dot com. That website, along with appointment links for all four practices, is in the description of this episode.

Claire: One last reminder. In an emergency, call 911. In a crisis, call or text 988.

Claire: This podcast is a production of Hope Health Network Media.

Claire: You've been listening to episode 7 of Between Visits, Lung Cancer Screening: Who Qualifies for a Yearly Low-Dose CT Scan. Thanks for hanging out with us. See you next time!