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Diagnosis

Diagnosis

December 14, 2021
Emily Cassidy, MD
Emily Cassidy, MD

Cardiothoracic Surgery

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Because the survival of lung cancer is so much dependent on the stage of the lung cancer, there’s a big want in the community to diagnose more early stage lung cancers, as opposed to advanced stage lung cancers. Traditionally, the majority of lung cancers are diagnosed at a later stage because that’s when they become symptomatic. Early stage lung cancers for the most part are asymptomatic, which begs for a screening tool to be able to identify those early stage lung cancers so that we can both diagnose and treat them before they become advanced and symptomatic. The National Lung Cancer Screening Trial in 2011 proved a 20% reduction in lung cancer mortality with patients who were screened with annual CT scans. Now, the patients who were studied in that group were aged 55 to 74, who were either a current smoker or a former smoker who had quit within the past 15 years and who had a 30 pack year smoking history. A pack year is defined as the number of packs smoked per day multiplied by the number of years smoked. So a 30 pack year history could indicate one pack per day for 30 years or two packs per day for 15 years or a half a pack per day for 60 years. Based on those criteria, patients should be, if they fall into that category, undergoing an annual low dose CT scan. Now, what does that entail? It’s essentially just lying on a radiology table and going through a large donut shaped machine that takes 3d pictures of the lung itself to look for nodules that are concerning for lung cancer. When a nodule is identified, it’s typically evaluated by a multidisciplinary team to determine how concerning that lung nodule is for being representative of a lung cancer. And based on that, further recommendations can be made for repeat imaging or biopsy or even surgical resection. But the take-home point is that it’s a noninvasive test that’s covered by Medicare and most private insurance companies with the idea of identifying lung cancers at an early stage before they become symptomatic and where they’re more treatable and much more survivable.