Screening tests for lung cancer

Screening of the general population is not done for lung cancer. This is because studies have not found that tests such as X-rays or looking for cancer cells in coughed-up mucus (sputum cytology) actually save lives. Still, low-dose CT scans may help find lung cancer early in certain people at higher risk.

Low-dose CT (LDCT) scan

This test is also called a spiral CT scan. It uses X-rays to create detailed 3-D pictures of your lungs.

To have this test, you lie still on a narrow table as it passes through the center of the ring-shaped CT scanner. A CT scan is painless. No special preparation is needed before the scan. You may be asked to hold your breath a few times during the scan.

An LDCT scan can show some abnormal areas that a chest X-ray might miss. But these areas often turn out not to be cancer. You may need more tests to be sure.

It’s not clear if LDCT scans can find cancer in people who aren't heavy smokers or who haven't smoked at all. It’s also not clear if the test can find cancer in people younger than age 55. So far, studies have only been done on heavy smokers ages 55 to 74.

LDCT scans also have some downsides. They find many abnormalities that turn out not to be cancer but that still need more testing to be sure. This can make people feel anxious. It may also mean unneeded tests such as more CT scans. Or more invasive tests, such as biopsies or surgery may be done, even when a person doesn't have lung cancer. LDCT scans also use a small amount of radiation during each test.

Who should get lung cancer screening

Several expert groups have put out lung cancer screening guidelines. These include the U.S. Preventive Services Task Force (USPSTF), the American Society of Clinical Oncology, the American Cancer Society, and the National Comprehensive Cancer Network.

The guidelines vary a little among expert groups, so talk with your healthcare provider about your risk and personal situation. The USPSTF advises that people who smoke be screened every year with low-dose CT (LDCT). Or they should talk with their provider about yearly screening if they meet all of the following:

• Are age 50 up to 80. (Check with your insurance plan, because some plans have age limits.)

• Are current smokers or have quit in the last 15 years

• Have a 20 pack-year history of smoking. A pack-year is 1 pack of cigarettes per day per year. So, 1 pack per day for 20 years or 2 packs per day for 10 years would be 20 pack-years.

The USPSTF says that screening can stop once a person has not smoked for 15 years or has a health problem that limits their life expectancy or their ability to have lung surgery.

Expert groups also recommend that screening be done at a center that has experience with screening. The center should also be able to offer tests and treatments that might be needed as a result of screening. Expert groups differ slightly in their advice, so talk with your provider about your risk and situation.

Talk with your healthcare provider

If you have a history of smoking, talk with your healthcare provider about whether yearly lung cancer screening might be right for you. It's important to think about your risk for lung cancer and whether screening could help you. You should also think about the limits of screening and the risks that might come along with testing. 

Another thing to talk about is cost. Not all insurance plans pay for annual lung cancer screening.