Lung Cancer Screening Saves Lives, So Why Don’t All Eligible Smokers Get Screened?

November 6, 2019

Lung cancer is the leading cause of cancer death in the United States, with about 220,000 people diagnosed each year. One reason this cancer is so deadly is that it is usually fairly advanced by the time symptoms show up. 

For people between the ages of 55 and 80 who smoke or quit smoking within the last 15 years, a low-dose computed tomography (CT) scan can detect lung cancer while it is still at a treatable stage — before symptoms appear. But studies have shown that this screening tool is heavily underutilized despite insurance coverage, recommendations by the US Preventative Task Force, and its potential to save lives.

Male patient in CT scanner
A low-dose computed tomography (CT) scan can detect lung cancer while it is still at a treatable stage. Photo by Jorg Meyer.

“For eligible smokers, it should be part of their annual checkup, like bloodwork,” says Valerie Maccarrone, MD, assistant professor of radiology at Columbia University Irving Medical Center and medical director of ColumbiaDoctors Radiology Tarrytown in Westchester, NY.

Dr. Maccarrone and her team have developed a lung cancer screening program that prioritizes patient experience, in the hopes that more eligible smokers will take advantage of this potentially life-saving tool.

“It’s an anxiety-provoking study,” explains Dr. Maccarrone. “People come scared, or depressed. There’s a lot more to it than looking at a CT scan and finding out what it shows.”

Most patients never meet the radiologist who reads their scan. Results are generally sent to the referring doctor, who shares the results with a patient by phone or in person. For the patient, that means that the scan itself is followed by hours or days of waiting for results.

Dr. Maccarrone and her team have eliminated the stressful waiting period by sending patients home with their results. Dr. Maccarrone meets with each patient personally — twice.  Before the exam she explains the test and gives patients the opportunity to ask questions. Then, she reads the CT immediately and she and the patient meet a second time to go over the results.

A lung cancer screening looks for nodules in the lung, which are fairly common and usually non-cancerous. Using guidelines from the American College of Radiology, a radiologist will make recommendations based on the size and appearance of a nodule. If a nodule looks suspicious, the radiologist may recommend a follow-up CT scan in a few months, or, in the case of highly suspicious nodule, either advanced imaging or a biopsy. 

80 percent of nodules do not require any follow up other than a regular annual CT screening.

Dr. Maccarrone says that she sometimes finds other things, such as emphysema, coronary artery calcification, and even an aortic aneurysm. Whether it’s a suspicious nodule or something else that that needs further exploration, she calls the referring physician before giving complicated results to a patient. A quick conversation with the doctor, she says, can fill in critical information about a patient which will help her approach. “Whenever it could be beneficial to have a direct discussion, I call the patient’s health care provider,” she explains. “I share in the responsibility for the care of the patients.”

Most of the time, she says, she’s delivering good news. And taking the time to deliver the results personally has shown her how intense the relief can be.  “I’ve had patients start crying when they receive good news,” she says. “I’ve even gotten a hug.”

Dr. Maccarrone and her Tarrytown team are part of a growing trend of patient-centered radiology practices, where radiologists are becoming a more integral part of a patient’s experience.

“The radiologist is part of the process,” she explains. “When we’re finished discussing their results, I tell them, the best thing you can do for yourself is to stop smoking.”