In principle, “screening” is looking for cancer in people who have no symptoms but are at high risk of developing cancer. This can help find cancer at an early stage, and potentially save lives. Lung cancer is the most common cause of death from cancer in both men and women in South Africa, and the majority of cases are diagnosed too late to cure.
It is important to remember that your doctor or medical aid does not necessarily think you have cancer if he or she suggests a screening test. Screening tests are given when you have no cancer symptoms. Furthermore, if a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.
It took researchers many years to find the best tool for lung cancer screening, as normal chest X-rays were unfortunately found not to adequately screen for lung cancer. We know now that a “low dose CT-scan” (LDCT) is the best investigation, and annual screening saves the lives in heavy smokers. Large international studies have identified individuals who are more likely to benefit from screening, and current South African guidelines suggest that lung cancer screening should focus on:
- People aged 55-74 years and have never been diagnosed with lung cancer.
- Current or former smokers (having quit within the preceding 15 years) who smoked on average a pack of cigarettes (20) for 30 years.
- People who are generally in good health, fit for surgery, and willing to undergo further tests should an abnormality be detected.
Unfortunately, even with the best technology, the LDCT can both miss or overcall cancer and
sometimes provide results that are difficult to interpret (even by experts). LDCT scans also expose
the chest to radiation, but fortunately, this is only 1/7 th of a routine CT scan or 10 times that of a
chest x-ray.
Once you have decided to be screened, you should first fill in an online questionnaire to identify your risk and eligibility for the program. You should then visit your doctor or contact a counselor for more information, whereafter (if appropriate) you will be referred to an accredited center to perform the screening (accredited by the Radiological Society of South Africa). Results will be commutated to you, and a suggested course will be suggested, which could include annual follow-up LDCTs or, in certain cases, evaluation for cancer with a range of investigations. Further evaluation will be performed in centers that have been accredited by the South African Thoracic Society. All further investigations will be discussed with you by the specialists involved, and it remains your right to refuse investigations or ask for a second opinion.