Ask Us Anything About… Lung Cancer Screening

Two people in white coats are seated at computer terminals, looking at x-rays.

Lung cancer is more likely to be cured in its early stages. The trick is catching it early – because once symptoms develop, a cure may no longer be possible. Studies show lung cancer screening reduces the risk of dying of lung cancer. Dr. Brian Bentley, a radiologist at Penn State Health, shares insights on who should be screened and how the process works.

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Description – The video begins inside Penn State Health St. Joseph Medical Center. Standing from left to right are Scott Gilbert and Dr. Brian Bentley

Scott Gilbert – Live from Penn State Health St. Joseph Medical Center. This is Ask Us Anything About Lung Cancer Screening. I’m Scott Gilbert. Well, lung cancer is more likely to be cured in its early stages. The trick is catching it early because once symptoms develop, a cure may no longer be possible. Studies show lung cancer screening reduces the risk of dying of lung cancer. But the big question is who should pursue screening. That’s actually one of many questions we’ll get answered today with Dr. Brian Bentley. He’s a radiologist at Penn State Health. Dr. Bentley, we appreciate your time today. Let’s start with that question of who. Who fits into that, what we consider a high-risk category and should, therefore, consider being screened for lung cancer?

Dr. Brian Bentley – Well, those patients that have significant smoking history and are a certain age range are eligible potentially for lung cancer screening. Medicare determines that patients that are between the ages of 55 and 77 who have a 30-pack-year smoking history, as well as those being asymptomatic, are candidates for lung cancer screening.

Scott Gilbert – Now, explain what you mean by a 30 pack-year history because that doesn’t mean 30 years of a pack a day, although it could, but it means some other things too.

Dr. Brian Bentley – That’s correct. So to determine the number of pack-years, you determine the number of packs of cigarettes you smoke per day and multiply the number by the number of years you smoked that amount. So somebody who did smoke one pack a day for 30 years would have a 30 pack-year history, as would somebody who smoked two packs a day for 15 years.

Scott Gilbert – Okay. And when it comes to people who used to smoke but quit some time ago, does that remove them from the risk category or should some of them get screened too?

Dr. Brian Bentley – It necessarily does not. So patients who have a smoking history and have quit could still be candidates for lung cancer screening. What you need to do is make sure that the time since you’ve quit is less than 15 years. If you quit more than 15 years ago, congratulations. Your risk has dropped significantly. You’re no longer a candidate for lung cancer screening.

Scott Gilbert – You’re watching Ask Us Anything About Lung Cancer Screening from Penn State Health. Dr. Brian Bentley, a radiologist, welcomes your questions. So feel free to add those to the comment field of this Facebook post. And we hope you find this information interesting and that you’ll share it on your feed to help it reach more people. And we’re talking about some rather specific guidelines here, Dr. Bentley. I’m wondering who came up with those? How do guidelines like that get researched and eventually put into place?

Dr. Brian Bentley – Sure. So in the early 2000s, the National Cancer Institute commissioned a study called the National Lung Cancer Screening Trial. The results of that trial were published in 2011. Based on that data, several national organizations, including the US Preventive Services Task Force, went ahead and recommended that lung cancer screening be performed with a low-dose chest CT. Based on those recommendations, Medicare, as well as private insurers, have determined that certain patients, within their own eligibility criteria, would be candidates to be screened for lung cancer with chest CT.

Scott Gilbert – And we’re talking about lung cancer screening. So that raises the question: What does that involve? What are the various types of screening? There is pretty much just one, right?

Dr. Brian Bentley – Yeah, that’s correct. So, currently, the only recommended screening test for lung cancer is something called a low-dose chest CT scan.

Scott Gilbert – And tell us a bit about what that involves because I think a lot of us have had CT scans. But how is this one different?

Dr. Brian Bentley – This one’s a little bit different. So the chest CT scan is a CT scan where you have to lay on your back on a CT scan or table, hold your breath for a few seconds. Does not require an IV or contrast or anything like that. There’s no special preparation necessary. What it does is it will do a scan basically from the top of the lungs to the bottom of lungs, looking for any specific findings, nodules, anything that may be suspicious for lung cancer.

Scott Gilbert – So when it comes to preparing for the test and what do I need to do the day of, it sounds like it’s pretty low maintenance.

Dr. Brian Bentley – Not much. Really, the thing we would recommend for anybody who’s going to be having this type of test is to remember, try to think back if you’ve had any CT scans in the past, whether the chest or the abdomen, which may have clipped a little bit of the lungs, and try to have those images available at the facility where you’re having the scan done because a comparison is always helpful.

Scott Gilbert – And as a radiologist who reads scans like that, what are you looking for on those? In lay terms, what are some of the abnormalities that could trigger some findings?

Dr. Brian Bentley – So what we’re looking for are lung nodules, nodules that range in size and may have a variety of characteristics, which may indicate that they could be suspicious or benign. And so, depending on what the nodules look like to the trained radiologist, it may prompt some further testing.

Scott Gilbert – Right. Now, I have to be honest. A few years ago when I had pneumonia, I had a series of CT scans. And one of them showed a nodule. I got really concerned. But apparently, that’s not always warranted because a lot of nodules are benign.

Dr. Brian Bentley – That’s correct. The vast majority of nodules that we see on CT, whether it’s a screening CT or a CT for something else and they’re incidentally detected, are benign. But certain nodules we know are precursors or early stages of cancer, and so we need to follow those and evaluate them if they have these suspicious features that we’re looking for.

Scott Gilbert – We’re live at Penn State Health St. Joseph Medical Center for Ask Us Anything About Lung Cancer Screening as we talk with Dr. Brian Bentley. We welcome your questions and your comments. Just add those to the comment field. Even if you’re watching this interview after the fact, we can get you some written answers to any questions that you might have. Lung cancer is especially deadly. There are some very scary stats about it. So I think those statistics really speak to the importance and the benefits of getting screened, right?

Dr. Brian Bentley – That’s correct. Lung cancer deaths account for approximately 25% of all cancer deaths in the United States. It’s the leading cause of cancer death in the US. The benefits of lung cancer screening is that it’s been shown to reduce the mortality related to lung cancer death by 20%. So if we do screening studies before patients are symptomatic, we can find these earliest stages, which can help increase the survival rates.

Scott Gilbert – So when you say before they’re symptomatic because lung cancer is, unfortunately, one of those cancers that you can’t wait for symptoms, right?

Dr. Brian Bentley – That’s correct. And, in fact, if you are symptomatic, you wouldn’t be a candidate for screening CT. You’d be necessary to have a diagnostic CT. If you’re asymptomatic, we want to catch it before it’s become symptomatic because that’s usually an indicator that something has progressed to the point where it makes treatment more difficult.

Scott Gilbert – Stage III or stage IV, which can mean what?

Dr. Brian Bentley – Well, it could mean metastasis, the lung cancer has spread to other parts, other organs in the body. And then, again, means that the treatment regimens are a little bit more difficult, more intensive and, unfortunately, less successful.

Scott Gilbert – Again, go back to the screening, having that done before the symptoms kick in could really help to save somebody’s life literally.

Dr. Brian Bentley – Absolutely. We know that we reduce the mortality by 20% for the population of patients that get screening CT. And so, if you meet the eligibility criteria, it’s very critical to go ahead and make an appointment with your doctor to see if you’re a candidate.

Scott Gilbert – Now, among the various findings that can come back from that CT scan is an indeterminate result. What does that mean?

Dr. Brian Bentley – So the American College of Radiology is the organization that determined how we report these type of exams. They have a very specific reporting construct called Lung-RADS. And so, based on what the nodule’s specific appearance is, the nodule will fit into one of these categories. Most are either negative or benign, but a significant portion, about 25% or so, are either indeterminate or unknown or highly suspicious. And based on that, there will be required additional testing to evaluate those which are not definitely benign or negative.

Scott Gilbert – And I know you’re a radiologist, so screening is your thing. But if a finding is concerning, what are some of the next steps then beyond the CT scan to try to figure out what’s going on?

Dr. Brian Bentley – Great question. So it really depends on what it is and what is the level of suspicion of the finding. With the lower level suspicions, we may just recommend to do a repeat low-dose chest CT scan in six months, a short interval. If it’s a little bit more concerning and has really more suspicious features, then we may do something a little bit more significant such as a PET CT scan or even maybe a potential biopsy, which is a procedure which will grab a little sample of the nodule or the finding, have it looked at under a microscope by a pathologist, who tells us whether this is cancer or not cancer.

Scott Gilbert – You’re watching Ask Us Anything About Lung Cancer Screening from Penn State Health. Some great information today from dr. Brian Bentley. He’s a radiologist with Penn State Health. And, you know, if you or a loved one fit into that risk category we talked about, that 30-year pack history of smoking, this is definitely something you need to pay attention to and maybe have a conversation with that family member about. You know, I’m wondering also if I get screened for lung cancer, is it possible it could lead to the discovery of other lung and even heart problems because you’re in that neighborhood? Could you find things like emphysema while you’re there?

Dr. Brian Bentley – Certainly. Smoking is a risk factor for multiple different disease processes. So the chest CT scan doesn’t just see the lungs; it sees multiple different organs in and around the chest. And so, often, we see evidence of coronary artery disease, which manifests itself as calcifications in the coronary arteries on a chest CT scan, which again would need to be evaluated in some form by your clinical provider. We also can sometimes find findings in the thyroid, the liver, even the kidneys. So it’s not uncommon that we do see other findings that will be described in the report and may prompt additional testing.

Scott Gilbert – Let’s say best possible outcome, nothing found, negative findings. When should that person get screened again?

Dr. Brian Bentley – So the current recommendations are to have screening done annually. So if it’s negative or definitively benign, then we’re going to go ahead and recommend that you have a repeat follow-up low-dose chest CT scan to be done in one year.

Scott Gilbert – Now, I’m sure a lot of folks watching understand that, okay, this sounds like it’s beneficial. But the big question is, is it covered by insurance.

Dr. Brian Bentley – Great question. Yeah, it should be. So if you meet that eligibility criteria as set forth by Medicare or your own private insurance company, then it should be without any co-payment, coinsurance, or deductible. But you want to be sure to check that the facility that you’re going to is in-network so that you don’t incur any additional charges.

Scott Gilbert – Really, the best way to prevent lung cancer though, it’s pretty simple, isn’t it?

Dr. Brian Bentley – Yeah. Smoking cessation or never starting to smoke in the first place will put you at the best odds of never developing it. As part of the initial consultation for lung cancer screening, your provider has to perform what’s called a shared decision-making visit, which they go over the risks and benefits of lung cancer screening, as well as discussion about smoking cessation. And there’s a lot of tools out there, whether it’s nicotine replacement products, prescription medications, different types of counseling, or even behavioral therapy to help reduce or get you to quit smoking.

Scott Gilbert – So yeah, it really is the number one risk factor for lung cancer. That said, there are other risk factors. Radon, for instance. You know, many, many basements in the central Pennsylvania region have a radon mitigation system as a result of that. How important is it to and I should say how, you know, can you screen for those other risk factors?

Dr. Brian Bentley – Yeah, certainly. So we already said that one of the eligibility criteria is to have a 30 pack-year smoking history. Some private insurances actually only make you have a 20 pack-year history if you have an additional risk factor, such as a personal history of cancer, a family history of cancer, or some type of exposure, whether in and/or out of the home. You mentioned radon gas, certainly something relevant here in Pennsylvania. So you’ll want to get your home checked for that. But occupational exposures, such as asbestos, arsenic, nickel, chromium, those all lead to increased risk for lung cancer.

Scott Gilbert – So if somebody’s watching now and they’re thinking, okay, I should or a family member should pursue this, should get screened for lung cancer it appears, what are those first steps in pursuing that screening and getting this done?

Dr. Brian Bentley – So you want to make an appointment with your health care provider, have that shared decision-making visit, discuss the risks and benefits, discuss smoking cessation, and see if you’re a candidate.

Scott Gilbert – Because lung cancer screening does save lives. We know that.

Dr. Brian Bentley – Absolutely.

Scott Gilbert – All right. Dr. Brian Bentley, thanks so much for your time today. Appreciate it. Dr. Bentley is a radiologist with Penn State Health. And we have a lot more information we’ll provide in the comment section here on how you can pursue a lung cancer screening or encourage a loved one to do so. I’m Scott Gilbert. Thanks so much for watching Ask Us Anything About Lung Cancer Screening live at Penn State Health St. Joseph.

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