Some Patients Fear Lung Cancer Screenings. Here’s Why They Shouldn’t.
Priya Patel, MD is an interventional pulmonologist who is board certified in interventional pulmonology, pulmonary disease, critical care and internal medicine at Inova Schar Cancer Institute. She has a special interest in the management of complex airways and pleural diseases, lung cancer, procedural education and procedure related quality improvement initiatives.
Working as part of a lung cancer screening program, I am accustomed to talking to apprehensive patients. When a doctor recommends screening, they naturally fear what’s to come. They wonder, “What if I have cancer?”
So, my work with patients starts with answering their questions and educating them on what we might learn from a lung cancer screening. The good news is the array of possible outcomes from a screening is wide, so there’s a lot less to fear than most patients think.
That’s a message we need to disseminate to more people. Because fear prevents too many people from getting screened. Screenings save lives, period.
You probably have an idea of how serious lung cancer is. It’s the second-most common cancer in the U.S., and the leading cause of cancer deaths. The American Cancer Society estimates that there will be more than 230,000 new cases of lung cancer in the U.S in 2022, and more than 130,000 deaths.
But screenings — specifically, low-dose CT screenings of those considered to have elevated risk for lung cancer — have proven to be effective. Studies including the National Lung Screening Trial found that these screenings reduce lung cancer deaths by up to 20 percent.
These screening statistics motivate me to get patients past their apprehension and get screened — be it at Inova Saville Cancer Screening & Prevention Center or elsewhere. And one of the best ways to do that is to explain the various possibilities.
Possibility 1: The Screening May Find Nothing
Annual lung cancer screenings are recommended for people who meet high-risk criteria — based primarily on smoking history and age. (The American Lung Association has an online tool you can use to determine your eligibility for screening.)
But there’s a big difference between being high-risk for lung cancer and getting a positive test. Many screenings are negative. If we don’t find anything, the patient can rest easy and come back in a year.
Possibility 2: The Screening Finds Something, But It’s Benign
About 90 percent of what we find during lung cancer screenings is not cancer. It’s often inflammation or evidence of an infection.
Inflammation could be a scar from a previous infection, or it could come from the fact that the patient is still smoking.
We may also find regular pulmonary nodules, pneumonia, or something cardiac-related. They may warrant treatment, but they’re not cancer.
We could also find a lesion that warrants further testing. When that happens, I explain the diagnostic process: How do we diagnose the lesion? What does a biopsy entail? And I note that there’s a chance that the lesion is not cancerous.
I have found that explaining these possibilities to patients is very reassuring — they should know that the majority of what we find is typically benign. And the screenings help us ensure they get the care they deserve.
Possibility 3: The Screening Finds Cancer
When a screening finds cancer, it’s important for the patient to know which issues we will address next. For instance, what kind of cancer is it? Has it spread to the lymph nodes?
Perhaps the lesion is very small, and we have not found evidence of cancer in any other parts of your body. At this point it is curative — we can treat it, either surgically or via radiation therapy.
Unfortunately, some patients carry the misconception that if we find cancer, then that’s it — life is over. But that’s not the case. We encourage screenings as soon as a patient is eligible because catching cancer early enables curative treatment in many cases.
Knowledge Is Power
If we need to take further action after a lung cancer screening, it’s important to make sure that patients understand what we’ve learned, and how we will execute the plan we create for them.
With that knowledge, patients often find the power to accept the outcomes that may follow.
And I also take this moment to make sure a patient understands my role. I make it clear that I’m here to help, and I’m here to take care of them, regardless of what we find. They need to know that they won’t be alone through this process.
I want to educate them, yes. But I also want them to rest assured that I have their back and I will take care of whatever comes next, whether it’s good or bad.
And in this regard, being part of Saville Center makes my job easier. It’s a one-stop shop for patients, meaning they can be screened and see the results in the same day, and the doctors they may need for the next steps are all in the same building. It’s what a cancer screening center should be.
Right now, lung cancer’s five-year survival rate is 18.6 percent. But that figure rises to 56 percent when the cancer has not spread beyond the lungs. Early screening and early detection are one way we can improve these rates. That’s why I continue to encourage eligible patients to get screened — and to fight the fear.
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