Most people who get lung cancer have non-small-cell lung cancer (NSCLC). It tends to grow and spread slower than small cell, the other main type. Your chances of survival go up if it’s found early.
“The earlier the stage [of the cancer], the more likely the treatment can cure the disease ... and the less treatment that’s necessary,” says Jacob Sands, MD, a medical oncologist at Dana-Farber Cancer Institute in Boston and a volunteer spokesperson for the American Lung Association.
Doctors use screening tests to find lung cancer before it causes symptoms. These imaging tests, or pictures, of the lungs are especially important if you’re at high risk for the disease because symptoms usually don’t appear until the disease is already at an advanced stage, says Mamta Kalidas, MD, a clinical assistant professor at Baylor College of Medicine in Houston.
Here’s what you need to know about screening tests, risk factors for lung cancer, and signs of the disease.
Should I Get Screened?
Many professional medical groups say you should get a yearly lung test called a low-dose CT scan if you’re at high risk for lung cancer. Different groups have different definitions of high risk, mainly based on your age and your past smoking habits.
To measure how much you’ve smoked over time, the groups use a figure called pack-year. That’s the number of packs of cigarettes you smoked per day multiplied by the number of years you were a smoker.
The U.S. Preventive Services Task Force (USPSTF) recommends getting screened for lung cancer if:
- You’re 50 to 80 years old,
- You have a 20 pack-year history of smoking (meaning you smoked one pack a day for 20 years, or two packs a day for 10 years, and so on),
- And you’re a current smoker, or you kicked the habit within the last 15 years.
“The USPSTF guidelines have recently been updated to reduce the amount of smoking history and reduce the age from starting at age 55 to starting at age 50, which about doubles the number of people that would qualify for screening,” Sands says.
The American Lung Association follows the USPSTF’s recommendations. If you think you might be high risk, Sands suggests visiting their “Saved By the Scan” webpage to find out if you qualify for lung cancer screenings.
“If you qualify, do it,” he says. “We’re talking about something that has the greatest potential for reducing cancer deaths than anything going on in oncology.”
It can make a huge difference, Sands says.
“With a screening test, the majority of people have an early-stage diagnosis, in which case it is curable, and in many cases just surgery is needed to cure the disease,” Sands says. “People who don’t get a screening test, the majority are not curable. We’re talking about a huge difference going from stage I to stage IV, and that is the difference between a screening test and not having a screening test.”
If you don’t qualify for screenings, talk with your doctor about what your risk might be and what you can do to lower it.
Kalidas says the American Cancer Society is updating their lung cancer screening guidelines. For now, ACS recommendations include getting screened if you’re 55 to 74 years old and you have a 30 pack-year smoking history (meaning you smoked a pack a day for 30 years, or two packs a day for 15 years, or three packs a day for 10 years, and so on).
“My best advice to people who smoke or have a history of smoking is to sit down with their doctor and discuss their risk of lung cancer and what might be best for their situation,” Kalidas says.
Why Don’t More People Get Screened?
Too many people who would qualify for lung cancer screening tests don’t get them, says Mara Antonoff, MD, an associate professor of thoracic and cardiovascular surgery at The University of Texas MD Anderson Cancer Center in Houston.
She thinks there are a few reasons for that. One is that there’s not enough awareness or knowledge about lung screenings among some primary care doctors and patients. Another obstacle for some, she says, is a doctor appointment called a “shared decision-making visit.” The Centers for Medicare and Medicaid Services requires this before a beneficiary can get the lung scan. Basically, you have to meet with your doctor to discuss the pros and cons of getting screened first.
Antonoff also thinks some patients who smoke get judged in ways that can lead to inadequate screening.
“There are stigmas associated with smoking that prevent people from getting appropriate care, appropriate treatment, appropriate screening,” she says.
What Else Can Raise My Risk for Lung Cancer?
In the U.S., cigarette smoking is tied to most lung cancer deaths. But even if you don’t smoke, other things can raise your chances of getting lung cancer, like:
- Long-term exposure to high levels of a colorless, odorless gas called radon at home, school, or work. You can buy DIY detection kits or hire a professional to check your home’s levels.
- Secondhand smoke
- Air pollution
- Being exposed to asbestos, diesel exhaust, or other certain chemicals at work
It’s less common, but some people get lung cancer even though they don’t have any known risk factors.
“This is not just a disease of smokers,” Antonoff says. “It’s a disease of people who have lungs.”
What Symptoms Can Lung Cancer Cause?
People often don’t have symptoms until their lung cancer is advanced, Kalidas says.
She recommends that you talk to your doctor right away if you have signs like:
- A new cough that won’t go away or gets worse
- Coughing up blood
- Sputum with streaks of blood in it
- New or chronic shortness of breath
- New chest pain
- Multiple bouts of bronchitis or pneumonia
These could be signs of other health problems that aren’t lung cancer. But “it’s best to find out what’s causing the symptoms so the problem can be diagnosed and treated, no matter what it is,” Kalidas says.
Your doctor will give you a physical exam and ask you about your health history. If they think you might have non-small-cell lung cancer, they may ask you to get certain imaging tests and lung biopsies to find out for sure.
What if I Have Non-Small-Cell Lung Cancer?
Talk to your medical team about your treatment options.
“Stage I to III, we treat with a goal of curing,” Sands says. “Essentially, when you get 5 years out from having completed all treatment, without any recurrence, it’s very, very likely that that is a cure.”
Stage IV lung cancer usually isn’t curable, although there are exceptions, he says. Still, treatment can improve your quality of life.
If you learn you have non-small-cell lung cancer and you smoke, ask the doctor to help you quit. Kalidas says some people newly diagnosed with lung cancer ask her why they should stop smoking. There’s a good reason.
“You tolerate treatment better and your body heals more quickly,” Kalidas says. And studies have shown that people who stop smoking after a diagnosis of lung cancer tend to have better outcomes than those who don’t.”
