the Anxiety of Low-Dose CT Scans for Lung Cancer Detection

Q: the Anxiety of Low-Dose CT Scans for Lung Cancer Detection

Hello： 1. <br>The presence or absence of a disease will not change the results of the report, regardless of whether you review the report. <br>Please return for a follow-up to discuss the report with your physician. <br>2. <br>Different populations cannot be directly compared in

Patients with severe anxiety disorder experience heightened anxiety during low-dose computed tomography (CT) scans?

Hello Doctor, I have two questions I would like to ask, and I hope you can help clarify them for me.
Thank you.
I have generalized anxiety disorder, obsessive-compulsive disorder, and health anxiety.
I am 41 years old, a non-smoker, and do not drink alcohol.
In my family, three relatives have had cancer: my uncle passed away from liver cancer, another uncle had oral cancer, and my second uncle, whom I remember passed away in his 70s, seemed to have lung cancer.
My wife is 39 years old, a non-smoker, and does not drink alcohol, and there are no cancer patients in her family.
My mother-in-law had a white spot on her chest X-ray years ago but did not pursue further examination; she is currently in good health.
My wife’s aunt also had an abnormal chest X-ray, but after further examination, the doctor said it was not serious.
Question 1: This year, my wife and I both had chest X-rays, and the results were normal.
Recently, I came across articles online about low-dose lung CT scans, and my wife and I decided to pay out of pocket for this examination.
The report has not yet come out.
However, I later read many articles discussing the drawbacks of low-dose CT scans, such as a high rate of false positives leading to unnecessary anxiety for many people, overdiagnosis resulting in unnecessary surgeries, concerns about radiation exposure, and a high likelihood of discovering lung nodules.
For smaller nodules, we would have to wait a year to see if there are any changes, which means living under the shadow of cancer for that year.
Additionally, I am unsure how many years we would need to monitor lung nodules to feel reassured, and I worry about the possibility of new nodules appearing, leading to a never-ending cycle of monitoring and living in fear of lung cancer.
I already suffer from severe anxiety and health anxiety, especially fearing cancer, so I become worried that any minor ailment might be cancer.
I frequently visit doctors seeking reassurance.
I am now concerned about whether I can handle the drawbacks of low-dose CT scans, particularly the fear of living under the shadow of lung nodules potentially turning into lung cancer after receiving the report.
I am considering not looking at the report at all, including my wife's report, because I worry about her just as much as myself.
However, not looking at the report also causes anxiety.
Doctor, given our family history, is it necessary for my wife and me to undergo this CT scan? What would you recommend I do now?
Question 2: I have looked at the cancer statistics from the Ministry of Health and Welfare.
At my age of 41, the incidence of lung cancer is about 30 cases per 100,000 people, which translates to a roughly 1 in 3,300 chance of developing lung cancer.
Some have mentioned that the detection rate of lung nodules is very high, with about 1 in 3 individuals having nodules detected.
The majority, 96% to 99%, of lung nodules are benign.
In other words, among those who undergo low-dose scans, about 1 in 3 will have nodules that need monitoring, and of those, 1% to 4% may be malignant, resulting in an approximate 1 in 300 chance of developing lung cancer.
I do not understand why if I do not undergo the low-dose CT scan, my chance of lung cancer is 1 in 3,300, but if I do undergo the scan, my chance increases to 1 in 300, which is a tenfold increase.
Doctor, where is the discrepancy here? I am thinking that unless lung nodules are 99.9% benign, the probability would then be 1 in 3,000.

JAMES, 40~49 year old female. Ask Date: 2023/05/10

Dr. Zhou Ziguang reply Pulmonology

Hello: 1.
The presence or absence of a disease will not change the results of the report, regardless of whether you review the report.
Please return for a follow-up to discuss the report with your physician.
2.
Different populations cannot be directly compared in data.

Reply Date: 2023/05/10

More Info

Understanding the anxiety surrounding low-dose CT scans for lung cancer detection is a multifaceted issue, especially for individuals with a history of anxiety disorders and a family history of cancer. Your concerns are valid and reflect a common dilemma faced by many patients and their families when it comes to cancer screening and the implications of diagnostic imaging.

Question 1: Do You and Your Wife Need Low-Dose CT Scans?
Given your family history of cancer, it is understandable that you might feel compelled to undergo additional screening. However, the decision to pursue low-dose CT (LDCT) scans should be based on a careful evaluation of risk factors and the potential benefits versus the psychological burden of the findings.

1. Family History: While your family history of cancer is significant, LDCT screening is generally recommended for individuals who are at high risk due to smoking history or other specific risk factors. Since both you and your wife do not smoke and have no personal history of lung disease, the necessity of LDCT may be less compelling.

2. Psychological Impact: Your anxiety and health-related worries are crucial factors to consider. The fear of potential findings, such as lung nodules, can lead to increased anxiety and stress, particularly if you are already predisposed to anxiety disorders. The possibility of false positives and the need for follow-up imaging can exacerbate these feelings.
3. Consultation with Healthcare Providers: It is essential to discuss your concerns with your healthcare provider. They can help you weigh the risks and benefits of LDCT in your specific context. If the potential for anxiety and overdiagnosis outweighs the benefits of early detection in your case, it may be advisable to reconsider the necessity of the scan.

Question 2: Understanding the Statistics of Lung Cancer Risk
Your calculations regarding lung cancer risk and the implications of undergoing LDCT are insightful. Here’s a breakdown of the statistics:
1. Baseline Risk: The baseline risk of lung cancer for a 41-year-old non-smoker is indeed low, approximately 1 in 3300. This statistic reflects the general population risk without any additional screening.

2. Risk with LDCT: The statistic that suggests 1 in 3 individuals undergoing LDCT may have lung nodules is accurate. However, it’s important to note that the vast majority of these nodules are benign. The 1% to 4% malignancy rate for detected nodules indicates that while there is an increased chance of finding something, the likelihood of it being cancerous remains low.

3. Risk Perception: The perception that undergoing LDCT increases your lung cancer risk from 1 in 3300 to 1 in 300 is a misunderstanding of how screening works. The LDCT does not increase your risk of developing lung cancer; rather, it increases the likelihood of detecting nodules that may or may not be cancerous. The key takeaway is that while the detection rate increases, the actual risk of having lung cancer remains low, especially in non-smokers.

Recommendations
1. Mental Health Considerations: Given your anxiety disorders, it may be beneficial to seek support from a mental health professional who can help you manage your fears and anxieties related to health and cancer. Cognitive-behavioral therapy (CBT) has been shown to be effective for health anxiety.

2. Informed Decision-Making: Before making any decisions about further imaging, consider discussing your concerns with both your primary care physician and a mental health professional. They can provide a comprehensive view of your health status and help you make an informed decision that aligns with both your physical and mental health needs.

3. Regular Monitoring: If you decide against LDCT, regular check-ups and discussions about any new symptoms with your healthcare provider can help alleviate concerns without the added stress of unnecessary imaging.

In conclusion, while LDCT can be a valuable tool for lung cancer detection, it is essential to consider your personal health history, family background, and psychological well-being when deciding whether to proceed with such screenings. Balancing the potential benefits of early detection with the risks of anxiety and overdiagnosis is crucial for your overall health.

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