Smoking is one of the top behaviors physicians advise patients on. As doctors, we are likely to ask you if you smoke, how much and how long. Patients who smoke are at risk for developing several medical conditions, including heart disease, stroke and cancer.
The most common cancer smokers can get is lung cancer. So how do you go about getting yourself checked?
Current research shows that computerized tomography, the CT or CAT scan, is best for checking for lung cancer. The National Cancer Institute (NCI) sponsors research on detecting cancer earlier and the methods used to do so. The National Lung Screening Trial, under the sponsorship of the NCI, reviewed research and the methods used to diagnose cancer.
They determined that a CT scan is far superior to a chest radiograph, also known as a chest X-ray, in finding abnormalities that could suggest cancer. These guidelines enable many physician practices to ensure that patients receive appropriate screening.
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First, the doctor will determine your pack years, a term we use to calculate your risk. Take the number of packs you smoke per day and multiply it by the years you’ve smoked.
Example: You have been smoking one pack per day for the last 20 years. Your pack years would be 20 (one pack x 20 years = 20 pack years). Or you used to smoke two packs per day for 15 years but quit 10 years ago. Your pack years would be 30.
Next, determine the following:
You are between the ages of 55-75, have no symptoms, smoked 30 or more pack years and continue to smoke or have quit within the last 15 years.
If you fit the category above, you need an annual CT lung scan.
If you’ve been smoking for at least 30 pack years, you need to see your doctor and request a CT scan of your lungs. If you are a former smoker but quit in the last 15 years, talk with your doctor about your risk.
If you are outside this group, do not fear. You may be eligible for a CT scan. If you’ve smoked at least 20 pack years (past or present) and are age 50-80, ask your doctor if you can get a chest CT. If you have new symptoms such as cough, wheezes, sputum with blood, difficulty swallowing, chest fullness or pressure, chest pain, hoarseness or weight loss, visit your doctor for an evaluation. These symptoms are common and can occur in many diseases; not all of them will be related to cancer.
Not everyone will need to rush to their doctors to get checked. If you are smoking less than 20 pack years, less than 50 or greater than 80 years old, or have quit more than 15 years ago, your risk of developing lung cancer is significantly less. Ask your doctor at your next annual exam if you need to consider lung cancer screening.
It is important to note that these decisions on getting tested must include discussing with your doctor the benefits, risks and eligibility of undergoing scanning. Be prepared for possible findings and next steps before undergoing the CT scan. Your doctor can outline the plan if an abnormality is found. You may undergo repeated CT scans or a biopsy if a sizeable nodule is seen. Some possible findings may be benign, meaning nonharmful. Your physician may also collaborate with other physicians depending on the CT scan findings. Finally, consider whether you would pursue treatment. Understand that the recommendation is for annual lung screening.
Most importantly, if you are still smoking, consider stopping. There are multiple medications available to assist in stopping tobacco use. Research shows that quitting at any age can lead to positive benefits.
For more information, here are the following resources:
Mazzone PJ, Silvestri GA, Souter LH, et al. Screening for Lung Cancer: CHEST Guideline and Expert Panel Report. Chest. 2021;160(5):e427-e494. doi:10.1016/j.chest.2021.06.063
https://www.cancer.gov/types/lung/research/nlst
Dr. Naznin Jamal is a Jefferson Regional Medical Center hospitalist.