Hey, everybody, it's Rishi Agrawal.
In this video, I'm going to be talking about lung cancer screening
and specifically the changes that were made earlier this year
regarding the eligibility criteria.
If you remember back in 2015, the Centers for Medicare and Medicaid
approved lung cancer screening with low dose chest CT,
but you had to meet certain eligibility criteria.
And in 2022, those eligibility criteria changed.
The first one was age.
So you had to be 55 to 77 previously.
Now the lower limit is 50 instead of 55.
And the upper limit didn't change.
It's still 77.
You have to have a 20 pack year history
now instead of a 30, pack year history in the old criteria.
If you don't remember how to calculate your pack your history, it's really easy.
All you have to do is take the number of packs you smoke per day
and then multiply it by the number of years you've smoked.
So if you smoke half a pack per day
for 30 years, that comes out to a 15 pack year history.
Or if you smoke one pack per day for 20
years, that comes out to a 20 pack year smoking history.
There were
other eligibility criteria and those didn't change.
So the other criteria were you have to be either a current smoker
or a former smoker who quit within the last 15 years.
Meaning if you quit 16 years ago, then you're no longer eligible,
but if you quit 15 years ago, you're still eligible.
Another important
eligibility criteria is that you should have no new symptoms of cancer.
For example, if you have a new cough or you're coughing up blood,
or if you have new weight loss,
those are all signs that you could have lung cancer.
So in that case, we don't want to do a low dose
chest CT on you, which is something that we do for lung cancer screening.
Instead, we would do a chest CT with contrast.
It's also important that you have no symptoms of pneumonia either.
Pneumonia can show up on a chest CT and it can actually obscure a tumor.
So what we're trying to do with lung cancer
screening is take a picture of your lungs when they're completely clear of
any infection.
And then finally, you need
an order for screening from your primary care provider.
And when you go to see your primary care provider,
you're going to have a shared decision making visit.
And all that means is they're going to make sure that you're eligible
like they're going to go over your age and smoking history.
They're going to go over the risks and benefits of lung cancer
screening with you.
They're going to go over smoking cessation with you if you're still smoking.
And then they're going to talk to you about the importance
of adherence to a yearly screening schedule.
And that brings up an important point, which is that
lung cancer screening is not a one and done test.
It's something that you do on a yearly basis.
What we do for lung cancer
screening is something called a low dose chest CT.
This is a painless test.
All you do is lie down on a CAT scanner
and you don't receive any contrast, meaning there's no injections of anything.
What we're looking for on CT
is something called a lung nodule, which is a small bit of tissue in the lung
and it can range from really small like one millimeter
to about the size of a quarter.
Sometimes when we look at a lung nodule,
we can tell right away that it's a lung cancer.
But most of the time, lung nodules are very small.
And we can't say right off the bat whether that lung nodule represents
a lung cancer or something benign, meaning
something that's not going to give you any trouble at all.
So let me just show you an example to illustrate this.
Here's a patient who came in for lung cancer screening,
and we found a nodule in their right lung, which I circled.
Based on the size of the nodule, we recommended that
the patient come back in 12 months for another scan.
Here's the other scan, and you can see that the nodule hasn't changed
so we can say with a high degree of certainty that this nodule is benign.
Let me show you another example.
Here's another patient who had lung cancer screening.
And you can see that there's a nodule in their right lung,
about the same size as the one I just showed you.
So we asked the patient to come back in 12 months.
And you can see that this nodule grew in that time.
So because of that growth, we can say that this is a lung cancer
and this patient can go on to have surgery to have it removed.
Now, if this patient didn't come back in 12 months,
then almost certainly this nodule would have grown even bigger.
And it's possible
that it could have spread to other organs like the brain, the liver or the bones.
That's why
coming back on a yearly basis is so important.
Most patients who we see actually do have small nodules,
and we can't always tell the difference between benign nodules
and malignant nodules based on one study, but it's that change over time
that helps us distinguish benign nodules from malignant nodules.
Unfortunately, we still have a lot of work to do.
Most patients who have a new diagnosis of cancer,
the cancer has already spread to distant organs.
What we're trying to do with lung cancer screening is find cancers
when they're still confined to their primary site in the lung.
The reason why we want to do that is because patients
whose cancer is still confined to the lung have a much better chance of survival
compared to those in which the cancer has spread to a distant site.
Okay,
so my take-home points for lung cancer screening.
Number one is that the eligibility criteria have changed.
The age range is now 50 to 77 with some private insurances going to age 80.
And the smoking history is at least 20 pack years.
Remember that lung cancer screening is not a one and done test.
It's a yearly program that you have to adhere to.
And finally, quitting smoking is still
the best thing that you can do for your health.
All right.
If you have any questions about this topic,
please put them in the comments below. Thanks