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You are having a counseling
and shared decision-making visit
because one of your caregivers has referred you
to the Lung Cancer Screening Program.
Screening is performed at our main campus
and at sites throughout the Cleveland Clinic health system.
You are here because we want to educate you
about the potential benefits
and harms of lung cancer screening.
We want to help you make a decision
that is in keeping with your values
about whether you should be screened.
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Cancer is the second leading cause of death
in the United States, just behind heart disease.
Lung cancer is the second most common cancer
in the United States after prostate cancer in men
and breast cancer in women.
More people die of lung cancer
than from prostate, breast, and colon cancers combined.
This is probably because lung cancer
is often found late in its course
when treatment is not as successful.
Lung cancer often has no early signs or symptoms.
Some patients may have a nagging cough
or shortness of breath.
Late signs include losing a great deal of weight
unintentionally, coughing up blood, unexplained chest pain,
and cough or shortness of breath that gets worse.
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A screening is a medical evaluation
that is used to find a disease
or to see if someone is at risk of developing a disease
or being harmed.
Screenings are performed in a group of people
who have a greater risk of developing that disease.
Examples include colonoscopies for colon cancer
or mammograms for breast cancer.
Screenings are different from other medical tests
because they are performed on people
who do not have symptoms or signs of the disease
and seem to be in good health.
Only a small percentage of people
who are screened for a disease
are actually found to have that disease.
Lung cancer screening is a program
and not just a medical test.
The Lung Cancer Screening Program includes counseling
and the shared decision-making visit,
the screening low-dose CT scan,
management of the test findings,
and a program to help those who still smoke to quit.
Lung cancer screening
uses a low radiation dose computed tomography
or low-dose CT of your chest
which provides detailed images of your lungs.
The goal of lung cancer screening
is to have fewer people die from lung cancer
by finding it at an early stage when a cure is possible.
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Lung cancer screening is recommended for people
who are considered more likely to benefit
than be harmed by screening.
We offer screening to those
who are at high risk of having lung cancer
and for whom the benefits of screening
would outweigh the risks.
The following conditions should be screened for lung cancer:
between the ages of 50 and 77 years old;
have smoked at least 20 pack-years, in other words,
have smoked one pack of cigarettes a day for 20 years;
have smoked within the past 15 years;
have no signs or symptoms of lung cancer;
and are healthy enough to tolerate
and benefit from treatment for lung cancer.
Approximately, one in 100 people a year
who meet these criteria and have a screening
is found to have a lung cancer.
After having a screening every year for three years,
approximately one in 300 people screened
will have avoided dying of lung cancer.
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As with any medical procedure,
there are some downsides to lung cancer screening.
Many people who are screened for lung cancer
will have nodules, which are small spots within the lungs.
More than 95% of these nodules are not cancer,
but are simply a small scar.
Medical professionals will analyze the nodules
to determine how likely it is that they are cancer.
Some nodules may look like a cancer
on the low-dose CT imaging,
but the only way to know for certain is to perform a biopsy
and look at the cells under a microscope.
Therefore, there will be times
that we would recommend an invasive procedure
such as a biopsy or surgery
for a nodule that looks like a cancer,
but may not actually be a cancer.
Possible problems related to seeing lung nodules
on the low-dose CT include finding and evaluating nodules
that are or are not cancerous,
anxiety at the thought of having a nodule in the lungs,
performing biopsies for nodules that are not cancerous.
This happens in approximately one or two out of 100 people
who are screened.
Major complications that can occur
during any invasive procedure, like a biopsy.
These occur in one or two out of 100 invasive procedures.
Over diagnosis and overtreatment.
Finding, evaluating, and treating a growing cancer
that may not have harmed you
if it had never been discovered.
The radiation exposure from a low-dose CT is very low.
One low-dose CT is approximately equivalent
to 15 x-rays, 50 cross-country flights,
or six months of natural background radiation.
In order for a lung cancer screening to be successful,
patients should return every year for a low-dose CT.
This means you would be having numerous CTs
over several years,
so the dose of radiation will add up over this time period.
The risk to your health from this radiation is not known,
but most experts feel it is very, very low.
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In addition to taking images of your lungs,
the low-dose CT will also take images
of the following areas in your body:
the structures in your neck and heart,
surrounding blood vessels, the organs in your upper abdomen,
the chest wall, and other muscles and bones.
During these tests, there is a chance that something else
inside or outside your lungs may be found.
This is called an incidental finding.
Incidental findings are medical conditions
that are discovered while looking for something else.
These conditions may not be related
to the current condition that is being treated
or screened for.
Common incidental findings that are found
during a low-dose CT scan include coronary artery hardening,
thyroid nodules, adrenal gland nodules,
and enlarged lymph nodes.
If one of these findings appears on your low-dose CT,
your screening team will advise you
on whether it needs further evaluation
and will connect you to the appropriate team if it does.
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If you choose to be screened,
you will have a low radiation dose chest CT scan.
During the scan, you will lie on your back on a table
that moves you through a large opening in a machine.
The machine takes detailed x-rays of your chest.
You'll be asked to hold your breath for 5-10 seconds
during the test.
The provider you meet with
will share the results of the scan with you
soon after they are available,
which is usually within a week.
If there are no findings that need followup,
you'll be scheduled to have your next screening visit
and scan in one year.
If there are findings that need to be evaluated further,
your provider will discuss them with you
and will help to arrange for any additional tests
or visits that are needed.
If you are a smoker,
your provider will also talk to you about quitting smoking
and will help you quit when you are ready.
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