lung cancer screeningRolling Oaks Radiology is starting a new lung cancer screening program following the recent recommendations of the U.S. Preventive Services Task Force (USPSTF) which last month recommended annual screening for lung cancer with low-dose computed tomography (LDCT) in persons at high risk for lung cancer based on age and smoking history.

The USPSTF found adequate evidence that annual screening for lung cancer with LDCT in current and former smokers ages 55 to 79 years who have significant cumulative tobacco smoke exposure can prevent a substantial number of lung cancer deaths. The largest trial, NLST, showed reduced lung cancer mortality of 16 percent and reduced all-cause mortality of 6.7 percent. This trial included over 50,000 asymptomatic men and women ages 55 to 74 years with at least a 30 pack-year smoking history.

Lung cancer is the third most common cancer and the leading cause of cancer death in the United States. The most important risk factor for lung cancer is smoking, which results in approximately 85 percent of all lung cancer cases in the United States.

Lung cancer has a poor prognosis, and nearly 90 percent of persons with lung cancer die of the disease. However, early-stage non-small cell lung cancer (NSCLC) has a better prognosis and can be treated with surgical resection.

The majority of lung cancer cases are NSCLC, and most screening programs focus on the detection and treatment of early-stage NSCLC. Although chest X-ray and sputum cytology have been used to screen for lung cancer, LDCT has greater sensitivity for detecting early-stage cancer.

Lung Cancer Screening Program Details

With our new screening exam, in addition to a low dose lung cancer screening CT scan, the patient will also be evaluated for coronary artery calcification using the same CT data set allowing the patient to be screened for coronary artery disease at no additional cost or additional radiation dose to the patient. CAC is specifically related to atherosclerosis, and its extent is a good marker of the total burden of coronary atherosclerosis.

The prognostic value of CAC score for cardiovascular events and all-cause mortality has been confirmed in multiple large prospective studies of different populations and ethnicities. It has been demonstrated that in asymptomatic patients, the absence of CAC is indicative of a very low risk for cardiovascular events, whereas the presence of large amounts of CAC is associated with significant increased odds ratio as high as 20 for future major adverse cardiac events (MACE).

Currently, evaluations for the early detection of lung cancer and coronary artery disease are typically performed separately. However, according to multiple prior studies, both can initially be assessed by using low-dose CT so that routine evaluation of coronary artery calcium as part of a lung cancer screening program can be accurately performed with the results proven to be comparable to those obtained using a dedicated coronary calcium scoring CT.

Coronary artery disease (CAD) is the most common type of heart disease and is the leading cause of all cause mortality in both men and women in the United States. Coronary artery calcification evaluation may alter medical management based on risk stratification and may be useful in helping those patients reluctant to continue on medications such as statins by demonstrating the presence of coronary artery disease.

We at Rolling Oaks Radiology are happy to participate in this new screening program for high-risk patients for lung cancer and coronary artery disease using only one single very low dose lung cancer screening CT protocol. We look forward in helping you and your patients screen for these deadly diseases. If you have any questions regarding this exam, please call one of the radiologists at ROR to discuss.


Roy Gottlieb, D.O., FSCCT