Who Should Get a Lung Cancer Screening?

Lung cancer remains the leading cause of cancer-related deaths in the United States, even as new cases and deaths continue to decline. Because lung cancer often develops without noticeable symptoms, early detection is especially important. 

If you’re 50 or older and currently smoke or smoked in the past, you may qualify for lung cancer screening. A low-dose CT scan can help detect lung cancer before symptoms appear, when it’s often easier to treat. 

“We need more at-risk people to get screened for lung cancer,” says Samir Makani, MD, an interventional pulmonologist at Scripps Cancer Center. “Lung cancer often has no symptoms until it spreads, making it harder to treat. This is why early detection through screening is so important.” 

Your doctor can help you understand whether you qualify for lung cancer screening and what to expect.

According to the U.S. Preventive Services Task Force (USPSTF), you may qualify for annual lung cancer screening if you: 

• Are 50 to 80 
• Have a smoking history of at least 20 pack-years 
• Currently smoke or quit within the past 15 years 

A pack-year is a way to measure how much you've smoked over time. For example, smoking one pack a day for 20 years or two packs a day for 10 years equals 20 pack-years. 

If you meet the criteria, your doctor may recommend a yearly low-dose CT scan to check for early signs of lung cancer, even if you feel healthy and have no symptoms.

Finding lung cancer early can make a big difference in treatment and survival. Regular screening with low-dose CT has been shown to reduce lung cancer deaths among people at high risk. 

“When we wait for symptoms to appear, lung cancer is often found at an advanced stage and is harder to treat,” Dr Makani says. 

According to the National Cancer Institute, only about 1 in 4 lung cancer cases are diagnosed before the cancer has spread. About half are diagnosed after it has spread to distant parts of the body. 

The difference in survival is significant. The five-year relative survival rate is about 66% when lung cancer is diagnosed before it spreads, compared with about 11% after it has spread. 

A low dose CT scan is the recommended test for lung cancer screening. It uses less radiation than a standard chest CT scan to create detailed images of the lungs. These images can detect small growths, called lung nodules, before symptoms appear. Most lung nodules are not cancerous. 

Here's what to expect during the scan: 

• Quick: The scan itself usually takes only a few minutes 
• Noninvasive: No needles or surgery are needed 
• Painless: You lie on a table that moves through the CT scanner 

Smoking is the leading cause of lung cancer, accounting for up to 80% of lung cancer deaths in the United States. Menthol and “low-tar” varieties are not safer alternatives. Smoking cigars and pipes also increases the risk. The longer you smoke and the more you smoke, the greater the risk. 

But lung cancer can also affect people who have never smoked. Other risk factors include: 

• Exposure to secondhand smoke  
• Radon gas exposure  
• Asbestos and certain workplace chemicals 
• Air pollution 
• Previous radiation therapy to the chest 
• Personal or family history of lung cancer 

Having a parent, sibling or child with lung cancer may increase your risk, especially if they were diagnosed at a younger age. This may be due to inherited genes, shared environmental exposures or both. 

While there is no guaranteed way to prevent lung cancer, there are steps you can take to lower your risk. 

Quitting smoking is one of the most important. No matter how long you've smoked, quitting can reduce your risk. You can also protect your lungs by avoiding secondhand smoke, testing your home for radon and limiting exposure to harmful chemicals at work. 

Keep in mind that having these risk factors does not automatically mean you qualify for lung cancer screening. Current guidelines primarily consider age and cigarette smoking history. 

If you have additional risk factors, including a family history of lung cancer, talk to your doctor about ways to lower your risk and whether screening is appropriate for you. 

Scripps offers lung screening through the Jana Oliphant Hackett Lung Cancer Screening Program, established in 2022 to improve early detection among people at high risk.  

The program is named in memory of Jana Oliphant Hackett, a lifelong athlete who never smoked and died of advanced lung cancer in 2021. It serves patients who meet USPSTF lung cancer screening guidelines. 

Before screening, patients meet with a healthcare provider to discuss the benefits and risks of a low-dose CT scan and establish a schedule for annual screening. 

The program offers: 

• Low-dose CT lung screening 
• Education and support to help patients quit smoking 
• Tracking of annual screenings and lung nodules to help ensure timely follow-up care 
• Access to specialists, including radiologists, pulmonologists and thoracic surgeons 

“We are working with our primary care doctors to raise awareness about this program. We want to help more at-risk patients get access to life-saving screenings,” Dr. Makani says. 

Medicare and many private insurance plans cover lung cancer screenings for eligible patients. Coverage requirements vary, so check with your insurance plan or doctor's office before scheduling. 

If you are 50 or older and have a history of smoking, talk to your doctor about whether lung cancer screening is right for you. Even if you quit years ago, you may qualify.  

Your doctor can review your smoking history, explain your screening options and help you decide on the next steps. 

Watch the San Diego Health video with Dr. Makani discussing the importance of early detection of lung cancer through screening.