When an Injury Turns into a Lung Cancer Scare

At the end of 2018, according to press reports, Supreme Court Justice Ruth Bader Ginsburg had early stage lung cancer surgically removed. Justice Ginsburg had what physicians call an "incidental finding." It was widely reported that Ginsburg's cancer was found during tests she received while being treated for a rib fracture. In other words, while physicians were treating her for something else, they stumbled upon early stage lung cancer. This is not entirely uncommon. Pulmonary nodules (small growths in the lung) are commonly encountered in clinical practice. Most of these nodules are not cancerous, or benign. They can be caused by previous infections or illnesses and sometimes there is no known cause. Some small lung nodules will turn out to be lung cancer.

So, what can you expect if you find yourself in Justice Ginsburg's situation and your doctor finds a spot on your lung while treating you for something else?

• First, your doctor will want to know if you have old scans or chest X-rays to compare to. If not, your doctor may suggest further imaging tests, like a CT scan or a PET scan, to get a better look at the nodule to help determine if it is cancer.
• Your doctor may want to perform a biopsy. A biopsy is a procedure that takes a sample of the tissue, so it can be looked at under a microscope to determine if it is cancerous or not. This might be done with a bronchoscope or needle aspiration.
• It might also be suggested that you don't take any action at all for now. This is called "watchful waiting." Sometimes the best course of action is to do another imaging test in 6-12 months to see if the nodule has changed or grown. The time frame will be based on the size of the spot and your risk factors, including smoking history.
• You can expect the time between when your doctor finds a nodule and finding out if it is cancer to take several days to weeks. This is nerve-wracking to say the least, but doctors need to be thorough with their assessment. Try to stay calm and remind yourself that most nodules are benign. If it is cancer, it is likely in an early stage and can be treated with surgery.
• You will discuss your options and next steps with your doctor.

Ginsburg's lung cancer was discovered accidentally but there are certain people who should be screened proactively for lung cancer. If you meet the high-risk criteria below, it is recommended you talk to your doctor about screening using a low-dose CT scan (LDCT). Even though chest X-rays can find some lung nodules they should not be used for screening purposes. LDCTs are much more sensitive and the only test recommended for lung cancer screening.

Talk to your doctor abut lung cancer screening if you are:

• Between 55-80 years of age if you have private and insurance or 55-77 and have Medicare.
• Have a 30 pack-year history of smoking (this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.)
• AND, are a current smoker, or have quit within the last 15 years

Not sure? Take our eligibility quiz. 

There are also patients who may have symptoms of lung cancer like shortness of breath, persistent cough or coughing up blood. If you have any of these symptoms, talk to your doctor right away.
Sometimes it is helpful to talk through your situation with a healthcare professional. Our counselors at the Lung HelpLine can help you understand what to expect. Call 1-800-LUNGUSA (1-800-586-4872) to get started.

To learn more about lung cancer and access support, visit Lung.org/lung-cancer.