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Ask the VA: Should I be screened for lung cancer?

Lung Cancer


LUNG CANCER is the leading cause of cancer death in the United States. It begins when abnormal cells in the lung grow out of control. Unfortunately, many times lung cancer does not show symptoms until it has spread to other parts of the body. However, the most common type — non-small cell lung cancer — can sometimes be cured if it is found early enough.

The more you smoke and the longer you smoke, the higher your risk for lung cancer. You should consider being screened for lung cancer if you have all three of these risk factors:

  • You are 55–80 years old
  • You are a current smoker or a former smoker who quit less than 15 years ago
  • You have a smoking history of at least 30 pack-years (this means 1 pack per day for 30 years or 2 packs a day for 15 years, etc.).

Exposure to Agent Orange is also identified as a risk for lung cancer.

What is screening?

  • Screening is looking for a disease before a person shows any symptoms. It helps find lung cancer in an early, more treatable stage.
  • Based on the Patient and Physician NLST Study Guide published on the website at, if a group of 1,000 people were screened once a year for three years, three fewer people in 1,000 would die of lung cancer after six years. This means that, instead of 21 people, 18 people per 1,000 would die of lung cancer.

Why not screen everyone?

  • There is no proof from research that it is best to screen everyone.
  • Screening people who are not at high risk or who are very ill may cause more harm than good. And false alarms can lead to more testing and risk of harm.

What are the symptoms?

If you notice any of the following, you should contact your health care team:

  • A new cough that doesn’t go away
  • A change in a chronic cough
  • Coughing up blood, even a small amount
  • Developing shortness of breath or chest pain
  • Losing weight without trying

What does screening cost?

If you are charged co-pays for your VA visits, you will be charged a $50 co-pay for the day you have the Low-Dose Computed Tomography chest scan (LDCT). Talk with the Lung Cancer Screening coordinator if you are charged co-pays. Scheduling the scan on the same day as another visit may decrease the total charges.

How is screening done?

  • The VA screens for lung cancer using the LDCT scan. This scan gives a detailed picture of your lungs.
  • In the radiology (X-ray) department, you will lie on a table and raise your arms above your head. Then the table will slide into the scanner. We will ask you to hold your breath for about 20 seconds during the scan.

How often should it be done?

Based on current research, screening should be done once a year for as long as recommended by your provider.

Is there a downside to screening?

Yes, all screening tests have both pros and cons.

  • False alarms: Screening for lung cancer by an LDCT scan may find something that is suspicious, but, after further testing, turns out not to be cancer. This is called a “false positive.” Based on the Patient and Physician NLST Study Guide, in a group of 1,000 people screened once a year for three years, 365 people would get a false positive result (they didn’t have lung cancer), and 26 people would get a true positive (they did have lung cancer).
  • Complications of further testing: According to that research, about 25 of the 365 people who got a false positive result needed to have extra testing that involved surgery or putting a tube in the body (these are called “invasive procedures”). About three people out of the 25 who had an extra test had at least one major complication from the testing or surgery. Complications can include bleeding, infections, or, rarely, a collapsed lung.
  • Radiation: Exposure to radiation from LDCT scans increases your risk of cancer by a very small amount. The VA wants to keep your chances of getting cancer from radiation very low. The VA does that by using the Low-Dose Computed Tomography scanners, which use much less radiation than a standard Computed Tomography scanner.
  • Stress/anxiety: It is normal to feel stressed or anxious while waiting for your results or if you suspect lung cancer. Most patients with suspicious findings are reassured when they learn that most of these are false positives. Your health care team wants to hear from you if you have stress and anxiety about your results so the team can help.
  • Over-diagnosis: Sometimes screening tests find cancers that would have never caused problems. This is called overdiagnosis. Unfortunately, it is often impossible to tell which cancers fall into this category, so there is a very small chance someone may be treated unnecessarily for a cancer that would not have harmed them.

What is the bottom line?

  • The pros: Research shows lung cancer screening reduces the risk of dying from lung cancer.
  • The cons: This benefit comes at some cost in terms of false positive results, extra tests and possible complications of these tests.

It is important that you weigh these pros and cons before you decide on screening. Every person is different. You should think about how you feel about the pros and cons and talk to your provider before deciding.

Regardless of your decision about screening, avoiding cigarettes is the most important thing you can do to lower your chance of dying from a variety of diseases, not just lung cancer. Quitting smoking helps with emphysema and heart and vascular diseases as well.

If you are still smoking and need help to quit, talk with your Manchester VA health care team and call 1-855-QUITVET (1-855-784-8838).


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