For the most part, people who smoke know that it’s bad for them. Smoking increases the risk of a number of health problems, from heart disease to erectile dysfunction to lung cancer. Heavy smokers (those who smoke more than five cigarettes per day) face an estimated lifetime risk of developing lung cancer of 24.4% if they’re male and 18.5% if they’re female, according to a European study from 2006. Compare this to a lifetime risk of 0.2% for men who never smoked, and 0.4% for women who never smoked.
To doctors, the advice couldn’t be plainer: quit smoking to improve health. Former smokers still have elevated risk of lung cancer over people who never smoked, but that risk is far smaller than the risk for people who do not quit smoking. Discovering and treating lung cancer early is one key to patient survival, and many smokers and former smokers undergo screening for lung cancer, either with a traditional chest x-ray or with the newer low-dose CT scan, which has advantages over x-rays.
Medical Imaging That Can Find Lung Cancers Earlier
Though the x-ray was the standard for diagnostic radiology to detect lung cancer, traditional x-rays often only detect lung cancers after they have progressed, when treatment options are fewer and more drastic, and when survival rates are lower. Low-dose CT scans were shown by a National Lung Screening Trial of more than 50,000 people ages 55 to 74 to result in a 20% lower chance of a person dying from lung cancer than people who had regular x-rays. This type of diagnostic radiology is now covered by Medicare for people ages 55 to 77 who have at least 30 “pack years” of smoking history. Low-dose CT can detect lung cancer earlier than x-rays, when cancers are smaller and more treatable.
Why Screening Can Be a Double-Edged Sword
Low-dose CT can literally be a lifesaver if it detects lung cancer early enough for the chances of successful treatment to be high. But it turns out there’s a flip side: some smokers use this “early screening” as an excuse not to quit smoking, the logic being, “If I develop lung cancer, the CT scan will catch it early enough to be cured.” In fact, nearly half of smokers in a small 2014 study of patient views on smoking cessation when low-dose CT screening is available said the availability of early screening lowers their motivation for quitting. Other misconceptions about low-dose CT screening included:
• Everyone benefits from screening
• Screening offers “protection” from lung cancer
• A negative screening test indicates a person has avoided the dangers associated with smoking
Radiologists must walk a fine line between underplaying the benefits of low-dose CT scanning and hyping the benefits enough that patients aren’t motivated to quit smoking.
Diagnostic Radiology and Speaking With Patients About Smoking Cessation
While screenings have been shown to be beneficial in terms of lowering the death rate for lung cancer in smokers or former smokers, clinicians must make it clear that the absolute best step they could take would be quitting smoking altogether, because lung cancer risk does drop off when a person quits. It’s important that doctors address misperceptions about low-dose CT screening and focus on the emotional responses (or potential for them) should an abnormality be detected through low-dose CT scanning. They should make it clear that early detection offers no guarantees, and cannot make up for a long smoking habit.
steleRAD Radiologists Help Patients Make the Most Informed Decisions
Radiologists are in a unique position to educate patients about how strongly the benefits of smoking cessation outweigh the benefits of low-dose CT screening. Information about what can and cannot be detected on low-dose CT, as well as the emotional upheaval that can follow a false-positive result (which happens in around 21% of first low-dose CT scans for lung cancer) are other important topics to discuss.
The Board-certified radiologists who own and operate SteleRAD have decades of comprehensive experience in every medical imaging modality, including low-dose CT scanning for lung cancer. If you are interested in learning how SteleRAD can assist your hospital, practice, or medical imaging center, we urge you to call 954-358-5250 or contact us online at any time.