lung cancer screening xray

A new CT screening test captures many views of the lungs, providing more detail than traditional x-ray lung cancer screening.

Any type of medical intervention – surgery, medications, even x-rays – involves some degree of risk. So the doctor or caregiver must always assess: Does the risk outweigh the benefit?

Lung cancer screening is a case in point. A new CT screening test captures many views of the lungs, providing more detail than traditional x-ray screening. This makes identification of early-stage lung cancer nodules more likely – and the earlier lung cancer is diagnosed, the greater the chance of survival.

But here’s the catch: CT scans emit small amounts of radiation, and accumulated radiation exposure increases risk for cancer. This puts Dr. Francine Jacobson and other radiologists at Brigham and Women’s Hospital (BWH) in an awkward situation. “I have to balance the risk for patients,” notes Dr. Jacobson, “between their exposure to ionizing radiation versus the benefits of the CT scan.”

The key to finding that balance is research – including a National Lung Screening Trial (NLST) that involved 53,000 participants, aged 55 to 74, all heavy former smokers. (BWH, led by Dr. Jacobson, was involved in the NLST research.) Half were screened with CT scans and half with traditional chest X-rays. The result: There were 20 percent fewer lung cancer deaths among those screened with CT scans compared to those screened with chest X-rays.

Meanwhile, at Coolidge Corner Imaging, the BWH Department of Radiology’s community location in Brookline,MA, patients (who can receive the CT scan only with a doctor’s referral) get help in assessing their own risk of lung cancer in conjunction with a low-dose lung cancer screening CT scan. “The dose is continually being revised and reduced,” notes Dr. Jacobson, “so that we can diminish radiation exposure.”

Following the announcement that the National Lung Screening Trial (NLST) reduced death from lung cancer by 20% in those who received three annual CT scans, the International Association for the Study of Lung Cancer (IASLC) issued a call for physicians to discuss lung cancer screening with patients who match the high-risk smoking history of the people enrolled in the National Lung Screening Trial (NLST): anyone 55-74 years of age with a 30-pack-a-year history of smoking, who is either a current smoker or a former smoker who quit within the last 15 years.

While we do not yet have formal lung cancer screening guidelines, these patients, according to the research, have more to gain than lose from the 15-minute CT screening.

– Linda W

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