Lung Cancer Screening in Southern New Hampshire

Annual low dose CT

Who should consider lung cancer screening?

Current recommendations and insurance coverage are not identical. A pack year means smoking one pack of cigarettes a day for one year. One pack a day for 20 years, or two packs a day for 10 years, is 20 pack years.

The decision includes your health, expected benefit, preferences, and willingness to complete follow up and treatment if needed. People who have never smoked are not routinely included in these U.S. screening recommendations.

Screening is different from diagnosis

• Screening looks for cancer before symptoms develop, using LDCT in eligible people at increased risk.
• Diagnostic evaluation investigates symptoms or an abnormal finding. Coughing blood, unexplained weight loss, a persistent new cough, chest pain, or worsening shortness of breath calls for medical evaluation.
• Surveillance follows a known nodule or monitors a person after cancer treatment. The imaging schedule and tests are tailored to that situation, rather than simply following annual screening rules.

Chest radiography (a chest X-ray) is not an effective substitute for LDCT lung cancer screening. PET/CT is not a routine screening test, and a blood test does not replace LDCT. Our liquid biopsy page discusses blood testing separately.

September 24, 2026 IARC / NEJM synthesis

What does the evidence show?

The September 24, 2026 New England Journal of Medicine Special Report, IARC Perspective on Lung Cancer Screening, summarizes an International Agency for Research on Cancer expert review of existing studies. It is an evidence synthesis, not a new clinical trial. It informs the forthcoming IARC Handbook Volume 21.

The IARC working group concluded that LDCT screening in people at high risk based on age and smoking history reduces deaths from lung cancer and the occurrence of advanced disease. These benefits depend on choosing appropriate patients, obtaining quality images, and completing the recommended follow up.

Foundational randomized trials include the U.S. National Lung Screening Trial (NLST), which compared LDCT with chest X-rays, and the European NELSON trial, which compared CT screening with no screening. Both support LDCT screening in appropriately selected people at higher risk. Their findings do not mean every person benefits equally or that every cancer will be detected.

What happens after a screening CT?

Screening facilities generally use the American College of Radiology's Lung-RADS system to classify findings and recommend follow up. An abnormal result is not a cancer diagnosis. Many lung nodules are benign, and not every nodule needs a biopsy.

Depending on a finding's appearance, size, and growth, the next step may be:

• Return to annual screening
• A repeat CT at a shorter interval
• A diagnostic chest CT
• PET/CT in selected cases
• Bronchoscopy or needle biopsy
• Thoracic surgical evaluation

Comparison with earlier scans is often critical. Please arrange for our office to receive the actual images, not only the written report. A normal screening result does not remove the need to evaluate new symptoms.

Benefits and limitations of screening

LDCT can identify lung cancer when treatment is more likely to be successful and can reduce the risk of dying from lung cancer. Screening also has harms that should be discussed before starting:

• False positives: a concerning finding may turn out not to be cancer, but can still lead to additional testing.
• Overdiagnosis: screening may find a cancer that would never have caused symptoms or shortened life. Treating it can cause harm without providing benefit.
• Radiation exposure: LDCT uses less radiation than a standard diagnostic chest CT, but repeated scans and repeat imaging add exposure and a small potential cancer risk.
• Unnecessary procedures: some people undergo biopsies or operations for findings that are ultimately benign. Complications can include bleeding, infection, or a collapsed lung.
• Anxiety: an uncertain result or waiting for follow up can cause distress.

Screening can also miss cancer and identify unrelated abnormalities that lead to further evaluation. Structured follow up and careful clinical judgment help balance these risks against the potential benefit.

Screening is not a substitute for stopping smoking. Help is available through Smokefree.gov and 1-800-QUIT-NOW.

Screening is becoming more individualized

Age and smoking history remain central to current U.S. eligibility criteria. Individual decisions also consider overall health, other lung cancer risk factors, life expectancy, previous imaging, and personal preferences. A screening recommendation and the plan for an existing nodule are different decisions.

Researchers are studying better ways to estimate risk, blood tests, AI analysis of CT images, patient navigation, and tools that use health records to identify people who may qualify for screening. These approaches are still being studied. None replaces LDCT, and their effect on patient outcomes remains uncertain.

When biomarkers may add useful information

Merrimack Thoracic & Esophageal Surgery may use selected biomarkers as adjuncts when they answer a specific clinical question. We consider whether a test is appropriate for the clinical setting, what its limitations are, and whether the result could change the next step.

Biomarkers do not replace LDCT screening, imaging follow up, or tissue diagnosis when needed. A negative biomarker result cannot rule out lung cancer, and a positive result does not by itself establish the diagnosis. These tests are interpreted with imaging and clinical findings, not in isolation.

Individual assessment

How we approach an abnormal screening CT

Dr. Mane reviews the actual CT images and prior imaging, not just the radiology report. The assessment brings together:

• Clinical risk, including smoking history, symptoms, relevant exposures, and other health conditions
• Nodule shape, edges, density, size, and growth over time
• PET/CT when appropriate, recognizing that it has limitations and is not a diagnosis by itself
• Selected biomarkers when appropriate to the question being considered
• Biopsy options, including bronchoscopy or needle biopsy guided by imaging, and their likely value and risks
• Lung function, overall fitness, surgical risk, and your preferences

Together, these findings guide whether to repeat imaging, obtain more information, pursue a biopsy, or consider surgery. A single scan, scan report, or blood test result should not make that decision on its own.