By Dr. Anthony Policastro

When I was a Hospital Commanding Officer in the Air Force, I had three separate instances where wives came into my office after their husbands had died.

They were working through the stages of grief. They had moved from denial to anger. Each of them had the same complaint. Their husbands had died of lung cancer, and it was clearly the doctor’s fault for not doing a Chest X-ray sooner.

The problem was that at that time, once a lung cancer was large enough to show on a routine Chest X-ray, it was too late for it to be cured. Therefore, it did not make a difference when the X-ray was actually done. Most patients died within six months.

Each of the individuals had been a cigarette smoker. Therefore, the chance of lung cancer was higher than it was in the general population.

Fortunately, our technology has changed over the years. We now know that CT scans can diagnose lung cancer when it is still in a treatable stage. We also know that lung cancer continues to kill 127,000 Americans each year.

Therefore, it is logical to do CT scans on cigarette smokers to look for lung cancer. When it is picked up in its early stages on CT scan, 80 percent of those individuals survive for another 20 years. It is not like the death sentence that the chest X-ray produced.

Mammograms have criteria for breast cancer detection. Pap smears have criteria for the detection of cervical cancer. Colonoscopies have criteria for colon cancer detection.

There are also criteria for CT lung cancer screening. The first criterion is age-related. You need to be between 50 and 80 years of age. For those individuals in that age group, there are two situations that would warrant an annual low-dose CT scan.

The first of those is related to the total number of years being a smoker. Individuals who have a 20-year pack history of smoking are eligible. Pack years are determined by the number of packs per day times the number of years.

An individual who smoked a half pack a day for 40 years has a 20-year pack history. An individual who smoked two packs a day for only 10 years also has a 20-year pack history.

Some individuals do not have that kind of history. For those individuals, the rules are that you qualify if you are currently smoking, regardless of pack years. You also qualify if you have quit within the last 15 years. For example, a 50-year-old who quit smoking at age 35 would qualify for a CT screening.

Individuals do not always get mammograms or colonoscopy as they should. However, both procedures have over 70 percent compliance.

For the 14 million individuals who qualify for CT screening, the number is much lower. In 2021, only 5.8 percent of eligible patients got screened.

Some of that is due to poor understanding. On a recent survey, only 38 percent of individuals even knew that CT scanning was the best method. The medical profession has to increase that number. That is one of the reasons for this article.

It is hard to understand why 94.2 percent of individuals who qualify for screening never bother getting it done. Spouses still have to grieve. However, they would grieve a lot less frequently if more people were aware of who is at risk and needs proper screening done.