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Talking to Your Patients About Lung Cancer Screening

Most lung cancers are caused by smoking, and many patients who use tobacco products are at high risk. Lung cancer screening helps catch cancer early, making it much less deadly.

Lung cancer is the leading cause of cancer death in the US for both men and women—and is responsible for 142,000 deaths each year. Smoking is the primary cause of this disease, and regular exposure to secondhand smoke also increases a person’s lung cancer risk by 20 to 30%.

These staggering statistics led to the creation of Lung Cancer Awareness Month, observed yearly in November, with the goal of raising awareness for prevention, early detection, and treatment of this deadly cancer.

The National Lung Screening Trial (2011), which looked at more than 53,000 people at high risk for lung cancer across the US, found that annual screening with low dose CT scans results in a 15-20% decrease in lung cancer mortality. This became the basis of the US Preventative Services Task Force’s recommendations for lung cancer screening.

All asymptomatic patients meeting the following criteria should be offered screening:

  • Ages 50 to 80

  • 20 pack-year or more smoking history

  • Currently smoke or quit less than 15 years ago.

Hilary Crittenden, a family nurse practitioner with Duke’s Lung Cancer Screening Program, helps navigate patients through the process of screening. Her first goal is to have a shared decision-making conversation with patients, discussing the risks and benefits of low dose CT screening.

“Lung cancer is the number one cancer killer in our country. It’s so deadly because most people don’t know they have it until it’s advanced, making it much harder to treat.” – Hilary Crittenden, MSN, FNP-BC
Hilary Crittenden, MSN, FNP-BC

Screening enables early detection of lung cancer, making it more treatable and improving the chances of survival. “A lot of patients are scared to get a screening CT, but when caught at an early stage, lung cancer can be curable with surgery,” explains Hilary, who previously worked with the thoracic surgery team at Duke and saw patients with a recent lung cancer diagnosis undergoing surgery.

As a tobacco treatment specialist, she would talk with patients about the importance of quitting smoking to improve surgery and treatment outcomes after a lung cancer diagnosis.

“A lot of these patients feel shame and embarrassment. I always tried quickly to say, ‘This is water under the bridge. Let’s focus on risk reduction. We want you to have surgery in the safest manner possible.’ This was often a big motivator for patients to work on quitting smoking.”

Another important part of her shared decision-making conversation with patients involves a discussion of lung cancer screening risks—mainly exposure to a small amount of radiation and the impact of a false positive result.

“A lot of patients will have lung nodules. Most are not cancer,” Hilary explains. “These patients usually just need to get an additional scan to see if the nodules are cancer. At times they will require a biopsy. Only about 4% of patients who have a lung nodule will have lung cancer.”

Other non-cancerous findings on a CT scan are usually scarring from an old infection or respiratory illness, inflammation related to smoking, or mucus plugging.

She tries to stress to patients that having the scan itself is easy and safe. “There are essentially no side effects. No IVs or dye. It’s totally painless, quick, and there are lots of locations in the Triangle area where patients can get screened.”

In addition to improving cancer outcomes, lung cancer screening is a great access point for talking to people about quitting smoking, as they are often considering quitting, says Hilary. “I think there is fear about lung cancer, and patients want to reduce their risk, which is why it is so important to connect these patients to a smoking cessation program.”

Learn more about lung cancer screening and evidence-based smoking cessation treatment at the next Duke-UNC Comprehensive Tobacco Treatment Specialist Training!


About The Author Rachael Joyner is a family nurse practitioner with the Duke Smoking Cessation Program. She holds a National Certificate in Tobacco Treatment Practice and received her Doctorate in Nursing Practice from the University of Florida. She loves working collaboratively with patients to help them become tobacco free.


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