Lung cancer screening aims to detect lung cancer at an early stage when treatment options are more effective and the chances of cure are higher.

In the UK, the National Screening Committee recommends targeted screening for people at higher risk of developing lung cancer. Screening programmes are designed to identify early signs of disease before symptoms appear, allowing earlier investigation and treatment where necessary.

Currently, lung cancer screening is not currently available on the NHS to all; private lung cancer screening can be useful for at high-risk who don’t show any symptoms.

What is lung cancer screening?

Screening means testing people for early stages of a disease. This is before they have any
symptoms.

For screening to be useful the tests:

• need to be reliable at picking up cancers
• overall must do more good than harm to people taking part
• must be something that people are willing to do

Screening tests are not perfect and have some risks.

It’s important to remember that lung cancer screening will not prevent you from getting cancer. It aims to find the cancer early when you have the best chance of cure.

Screening options for lung cancer

While chest x-rays were once considered for screening, studies have shown they do not significantly extend life expectancy in those screened. As a result, they are not recommended for lung cancer screening.

Low-Dose CT (LDCT) Scan: This is now the preferred method for lung cancer screening in high-risk individuals. LDCT scans use a lower dose of radiation compared to standard CT scans and can detect abnormal areas in the lungs, including potential early-stage cancers. Research has demonstrated that regular LDCT scans can significantly reduce the risk of dying from lung cancer in people at higher risk by identifying cancer before symptoms appear.

Who should opt for lung cancer screening

• Individuals aged 55–74
• People who currently smoke or previously smoked

Before deciding to be screened, people should have a discussion with a health care professional about the purpose of screening and how it is done, as well as the benefits, limits, and possible harms of screening.

People who still smoke should be counselled about quitting and offered interventions and resources to help them.

People should not be screened if they have serious health problems that will likely limit how long they will live, or if they won’t be able to or won’t want to get treatment if lung cancer is found.

Diagnosing lung cancer early means that treatment is more likely to work.

As with any type of screening, it’s important to be aware that, not everyone who gets screened will benefit. Screening with LDCT will not find all lung cancers. Not all of the cancers that are found will be found at an early stage. Some people with lung cancer that is found by screening will still die from that cancer.

LDCTs also expose people to a small amount of radiation with each test. It is less than the dose from a standard CT, but it is more than the dose from a chest x-ray. Some people who are screened may end up needing further CT scans, which means more radiation exposure.

Symptoms to look out for

• A new cough or cough that persists
• Breathlessness during normal activity
• Coughing up blood
• Persistent fatigue
• Chest or shoulder pain

Some symptoms such as a persistent cough lasting more than three weeks, unexplained breathlessness, or coughing up blood should always be medically assessed. While these symptoms do not necessarily mean cancer is present, they may require further investigation such as imaging or specialist respiratory assessment.

What Happens During Lung Cancer Screening

Initial Assessment

The lung cancer screening process begins with an assessment conducted by a Consultant.

During this assessment, you’ll be asked a series of questions designed to evaluate your risk of developing lung cancer. This could include inquiries about your smoking history, exposure to harmful substances, family history of cancer, and any existing respiratory symptoms.

Low-Dose CT Scan

If the initial assessment indicates that you are at a higher risk of lung cancer, you’ll be recommended to have a low-dose CT (computed tomography) scan.

Here’s what happens during the scan:

The CT scan is a painless test that uses X-rays and a computer to create detailed images of your lungs.

The scanner takes images from various angles, which are then combined to create a three-dimensional (3D) image of your lungs.

During the scan, you’ll lie on a table that slides into the CT scanner, a large, doughnut-shaped machine.

You might be asked to hold your breath for a few seconds while the images are taken to ensure they are clear.

Getting Your Results

After your CT scan, a radiologist (a specialist doctor trained in interpreting medical images) will carefully examine the images for any signs of abnormality.

You should receive your results within a few days.

Follow up

If the scan detects something abnormal, further tests may be required. In some cases, additional investigations may be required to examine the airways or lymph nodes in more detail in order to determine the cause of an abnormal finding. This could involve more detailed scans or a biopsy (taking a small sample of lung tissue) to determine if the abnormality is cancerous.

If lung cancer is suspected, you will require further evaluation and treatment.

If an abnormal area is detected, further investigations such as Endobronchial Ultrasound (EBUS) may sometimes be recommended to obtain tissue samples and confirm a diagnosis.

Possible Benefits of Lung Cancer Screening

Early Detection: Screening can catch lung cancer at an early stage when treatment is more likely to be effective. This significantly increases the chances of survival.

Targeted Screening: By focusing on people at higher risk, lung cancer screening can be more effective in saving lives.

Risks of Lung Cancer Screening

Radiation Exposure: Each CT scan exposes you to a small amount of radiation. While this is minimal, repeated exposure over time could potentially cause harm to the lungs.

False Positives: Sometimes, the scan might detect something that appears to be cancer but isn’t. This can lead to unnecessary further tests, such as additional scans or biopsies, which can cause anxiety and carry their own risks.

False Negatives: Occasionally, the screening may miss a cancer that is present, giving a false sense of security.

Overdiagnosis: Screening might detect lung cancers that would never have caused any problems during a person’s lifetime. This could lead to unnecessary treatments, including surgery, radiation, or chemotherapy, which have their own risks and side effects.

Making an Informed Decision

Understanding the benefits and risks of lung cancer screening is crucial in making the decision that’s right for you.

The evidence for lung cancer screening

Early detection makes it more likely that treatment can begin before the cancer has spread, so survival rates are much higher.

Major US-based organisations, including the American College of Chest Physicians, the
American Cancer Society, the National Comprehensive Cancer Network and the American
Society of Clinical Oncology, reviewed the evidence early in 2012.

The National Health Service has started to roll out screening programme too.

Conclusion

Lung cancer screening can be a valuable tool in detecting cancer early when it’s most treatable. However, it’s essential to weigh the benefits against the risks and understand that screening is not a preventative measure but rather a means to catch the disease early.

Individuals considering lung cancer screening should have a detailed discussion with their healthcare provider to make an informed decision based on their personal risk factors and the potential outcomes of the screening process.

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