Lung Cancer Screening

What is lung cancer screening?

Lung cancer screening looks for signs of lung cancer before you feel symptoms from the disease. Low-dose computed tomography (also called a low-dose CT scan or LDCT) is the test now recommended to screen for lung cancer. A CT machine scans the body and uses low-dose radiation to make a series of detailed pictures of the lungs. Screening allows for earlier diagnosis and treatment, which may slow or even stop the cancer from progressing. Many lung cancer deaths can be prevented by screening high-risk people every year.

Is lung cancer screening available through the World Trade Center (WTC) Health Program?

Yes. Annual lung cancer screening is now being offered as a medical benefit for eligible WTC Health Program members. Eligibility is based on age and smoking history.

Who is eligible to receive lung cancer screening through the WTC Health Program?

WTC Health Program members who are at high risk for lung cancer are eligible for annual lung cancer screening.
This includes individuals who:

• Are between the ages of 50 and 80 years old; and
• Have a smoking history of at least 20 pack-years (A “pack year” is smoking an average of 1 pack of cigarettes per day for 1 year. For example, a person could have a 20 pack-year history by smoking 1 pack a day for 20 years or 2 packs a day for 10 years); and
• Are current smokers or former smokers who have quit smoking completely within the last 15 consecutive years.

What lung cancer screening guidelines does the WTC Health Program use to ensure appropriate screening is conducted for lung cancer?

The WTC Health Program follows evidence-based screening guidelines set by the United States Preventive Services Task Force¹ (USPSTF). USPSTF is an independent group of national experts in prevention and evidence - based medicine.

What are the benefits to lung cancer screening?

Lung cancer screening may help your provider find cancer early. Finding cancer early may lower your chances of dying from lung cancer because it is usually easier to treat at early stages

What is the risk from lung cancer screening?

You should talk to your doctor to determine if the benefits of this test outweigh the risks for your specific medical situation.

One risk associated with LDCT scans is false-positive results. This occurs when an LDCT scan suggests lung cancer when, in fact, no cancer is present. False-positive results cause worry and anxiety, and can lead to follow-up tests and surgeries that are unnecessary and may be risky. Careful healthcare management can reduce these risks.

Another consideration is that individuals receive radiation during LDCT scans. Currently, LDCT is not felt to result in a significant radiation exposure, but there is the potential for harm because radiation from repeated scans can cause cancer in otherwise healthy people.

What if you qualify for LDCT screening, but have already received a chest CT scan?

LDCT screening is a benefit offered in the WTC Health Program. Some members in the WTC Health Program have been receiving chest CT scans for diagnostic and treatment purposes for various conditions since the very beginning of the Program.

If you have already received a chest CT scan and the recommendation was that repeat CT scans were not indicated, that recommendation may have now changed with the acceptance of LDCT as an important lung cancer screening tool for high risk patients. If you already received a CT scan and the recommendation was for a repeat chest CT scan at a future date then you should follow that recommendation.

In either case, inform your WTC Health Program clinical center so that they can integrate your results into a long-term plan that provides you with the optimal testing without duplication. You should not receive chest CT scans more often than recommended by your WTC Health Program clinical center. You also should not be in multiple LDCT screening programs because then the added radiation risk outweighs the benefit.

Are there any other proven methods for lung cancer screening?

No. Only LDCT scans without contrast are recommended for lung cancer screening. Chest-X-rays, chest-X-rays with sputum analysis, body scans, and biomarkers are not recommended for lung cancer screening. The first two testing methods are not accurate enough for early detection and whole-body scans do not provide any additional accuracy for finding lung cancer while exposing the patient to far greater and unnecessary radiation.

What happens if I get a negative result from an LDCT scan?

A negative result means the LDCT scan shows no cancer or other abnormal findings at the time. It does not mean you will never get lung cancer. Your doctor will tell you when you should be screened again. The WTC Health Program offers yearly lung cancer screening to members who are at high risk for lung cancer.

What happens if I get a “suspicious” result from an LDCT scan?

A “suspicious” result means that the LDCT scan shows that something is abnormal. This could mean lung cancer. It could also mean some other lung condition. It could also be a false-positive result. You may need to have additional tests to find out what is wrong. These tests are covered by the WTC Health Program. Your doctor will discuss the findings with you and advise you on what to do next.

When should screening stop?

Once started, LDCT should continue annually until you reach age 80, or you have completely quit smoking for greater than 15 consecutive years, or you develop a health problem that significantly limits your ability or willingness to obtain curative treatment, or you voluntarily withdraw from the Program.

Can the WTC Health Program help me quit smoking?

Yes. If you are eligible for the WTC Health Program lung cancer screening benefit, then you are also eligible to participate in a smoking cessation program at no cost to you. The smoking cessation program may include medication, nicotine replacement therapy, and counseling.

The most important way to prevent lung cancer is to not smoke and to avoid exposure to tobacco smoke. If you do smoke, quitting can greatly reduce your risk of developing lung cancer, and your risk will continue to go down over time.

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1. The WTC Health Program follows the USPSTF category A and B recommendations for lung cancer screening. Available at https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/lung-cancer-screening