What happens if my lung cancer screening results are abnormal?

Being informed you need a lung cancer screening can be a worrisome experience, but receiving results that say your screening came back abnormal can be genuinely frightening. However, an abnormal result isn’t necessarily a reason to worry. Pulmonologist Nicholas Fuerst, MD, offered an explanation on how lung cancer screenings work and what it means if your lung cancer screening has abnormal results.

How common is lung cancer?

“Lung cancer, a malignancy of the airways or lung tissue, happens when normal lung cells experience genetic mutations over time,” said Dr. Fuerst. “Ultimately, you end up with unchecked growth, creating tumors that could potentially spread out of the lungs to other parts of the body.”

Lung cancer is the second most common cancer diagnosis received in the United States, with 200,000 cases diagnosed every year. It’s also the leading cause of death from cancer in the USA.

Who is at the most risk for lung cancer?

“Cigarette smoking is the number one risk factor for developing lung cancer and accounts for 80-90% of all cases,” said Dr. Fuerst. “Radon exposure is the second leading cause.”

Other factors can also create a higher risk for developing lung cancer over time, including:

• Secondhand smoke
• Asbestos
• Air pollution
• Family history

What is a lung cancer screening like?

“When you are screened for lung cancer, low dose computed tomography imaging, or LDCT, is used for high-risk individuals,” said Dr. Fuerst. “An example might be a long-time smoker between the ages of 50-80, someone who has smoked at least one pack a day for 20 years, with their last cigarette within the past 15 years. LDCT can help us detect lung cancer before symptoms even develop.”

Each scan is categorized by the radiologist using the Lung-RADS system which places the scan into tiers based on the CT findings. If the scans are in the higher risk categories, the scans are reviewed at a weekly multidisciplinary conference involving radiologists, pulmonologists and thoracic surgeons.

“Ultimately, our goal is to catch lung cancer at an early stage in patients considered high risk, in order to give them the best opportunity for curative treatment,” said Dr. Fuerst. “At the end of the day, it can be boiled down to a screening process meant to save lives with early detection of cancer. This is very similar to the way we use screening mammograms for breast cancer or screening colonoscopies for colon cancer.”

What is a ‘nodule’ and what does it mean to find them in your lungs?

A lung nodule is a medical term used for a “spot” on the lungs that is seen on a CT scan or sometimes chest X-ray, if large enough. These spots are common, seen in up to half of adults who undergo CT scans, and almost always non-cancerous, also called benign.

Benign causes for lung nodules include:

• Granulomas, or old healed infections
• Lymph nodes
• Bacterial or fungal infections
• Nodules related to an autoimmune disease, such as rheumatoid arthritis
• Vasculitis
• And more

“Because of the relatively high rate of benign nodules, learning that a spot was found during your screening isn’t necessarily a cause for alarm,” said Dr. Fuerst.

Don’t assume that a nodule means cancer. Instead, speak with your health care provider about what further testing or workup that might be needed. This often involves referral to a pulmonologist, or lung specialist, to better understand the cause of these nodules.

What happens if my lung cancer screening comes back abnormal?

“The American College of Radiology uses a grading system called Lung-RADS to evaluate/grade every lung cancer screening CT scan,” said Dr. Fuerst. “When our radiologists read the CT, they use this grading system to characterize the CT findings into categories reflecting low to high risk for cancer.”

Based on these categories, recommendations are made to either repeat a CT scan at the normal annual interval if a scan is considered normal or low risk. You may also be asked to come in for another scan more quickly, receive a tissue biopsy or undergo a PET scan if your screening has abnormal findings.

Is surgery always recommended when a nodule is found on a scan? What other options might there be?

“No, surgery is not always recommended,” said Dr. Fuerst. “Again, most nodules are benign. If surgery was always recommended, we would be doing a lot of unnecessary surgery.”

If a nodule is found, we will recommend follow-up imaging after a specified time interval based on size and change in growth over time, to allow further characterization of the nodules. If the nodule is more concerning, we may recommend pursuing biopsy or PET scan.

Surgery can eventually be an option if a person is deemed a good candidate, but not until a diagnosis has been made of malignancy first. This is usually done through bronchoscopy (a scope into the lungs through the mouth) although there are other biopsy techniques.

How common is it to receive abnormal results on a lung cancer screening?

“Abnormal screening scans are very common, in some studies up to 25%,” said Dr. Fuerst. “The vast majority of abnormalities end up not being cancer, and only a small percentage of these abnormal scans end up leading to a biopsy. I always remind patients that abnormal scans do not necessarily mean they have cancer, but that we need to be diligent with regards to following the recommended plan to get a closer look, whether that be follow-up imaging or biopsy.”

The lung cancer screening program at Prisma Health brings together a multidisciplinary team of radiologists, pulmonologists and surgeons who work closely together to improve outcomes for patients.

“Our review of our internal data confirms we are making an impact by catching lung cancer at earlier stages,” said Dr. Fuerst. “Ultimately, this improves patient survival rates and helps us create a more effective treatment plan that suits each individual patient.”