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Lung Cancer Screening Question
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Lung Cancer Screening Question

Hello,

I was wondering if I could ask the opinion of a doctor on Lung Cancer Screening, particularly the current low dosage CT screening guidelines in the US.

I am a former smoker, 39 years old, recently quit. I was looking up lung cancer screening guidelines and determined that I don't fit into the first category of people for whom yearly low dosage screening is recommended, and I never will as I do not have anywhere close to 30 pack years of smoking.

My question is about the second category (recommendation 2b). I have calculated conservatively (meaning overestimated to be safe) and I came up with 19 pack years of smoking for me. Realistically, the number is probably closer to 17 pack years, or lower, but I overestimated to be safe.

Recommendation 2b indicates that you should be screened after 50 years of age if you have smoked 20 pack years or more, and have a secondary risk that would increase your chances of having lung cancer by 5% over 5 years. The additional risk factor that concerns me is Radon exposure. I am currently getting my home tested for Radon in the basement, as we spend a very large amount of time there. But I have also lived in two other houses over the time that I was a smoker, and at that time we did not test the homes for Radon levels.

My question then is, considering that I am close to 20 pack years (but most likely lower than 19 pack years) and the fact that I do not know about the Radon levels in my former two homes, should I be screened on a yearly basis for lung cancer through low dosage CT once I turn 50? And if my current home ends up having high Radon levels, is that considered a documented exposure to Radon, and again, would I need to get tested yearly at 50?

Thanks,
Dev
242587_tn?1355427710
The information you provided, including speculation on possible exposure to Radon suggests that you are probably on the “cusp” of the screening guidelines.  The first thing you should do is to discuss this question  with your doctor and/or a lung specialist (Pulmonologist) so that your total health status can be taken into account and, perhaps, other risk factors revealed.  The Guidelines (any guidelines) are always going to be somewhat arbitrary and subject to interpretation on an individual  basis.

Given what is at stake, I too would favor a conservative approach to application of the guidelines and opt to implement recommendation 2b when you reach 50.  Should another risk factor come to light or you discover evidence of definite radon exposure that would be a clear indication to follow 2b.

Once again, my best advice is that you have a two-way conversation with your doctor or one experienced in the diagnosis and treatment of lung cancer and the application of the Guidelines to your specific situationl.

I believe that you may find this Mayo Clinic summary of CT Lung Cancer Screening to be of interest:  http://www.mayoclinic.com/health/lung-ct-scan/CA00086

Good luck
2 Comments
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Avatar_m_tn
Thank you sir. I may have unintentionally overstated the risk of Radon exposure in my case. I am concerned about it due more to paranoia than fact (the area where all my homes have been located is not considered a high risk for Radon...96% of the population live in homes with acceptable levels of Radon). Of course I understand that if my current home tests for high levels that I should consider recommendation 2b, as 17 pack years is close to 20 pack years. But given what I have indicated about the area I live in, do you think I should still err on the side of caution and get screened yearly, even if this home is ok? I don't have a pulmonologist (don't have any respiratory issues I am aware of), but my family physician seems to think I am not at particularly high risk, and likely won't need to be screened when I am 50. I am also very concerned with the risks of the yearly test, including false positives and radiation exposure.
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