Coping with Anxiety About Abnormal Lung Cancer Screening

Coping When Your CT Lung Cancer Screening is Abnormal or Inconclusive

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How can you cope with anxiety when you get an abnormal CT lung cancer screening result?. Thomas Tolstrup/Getty Images

Are you wondering what to think and how to cope after hearing your lung cancer screening CT results are abnormal? Words such as inconclusive, indeterminate, and others can be terrifying, and hearing that "this happens all the time" doesn't do much to calm your fears.

Lung Cancer Screeing Results

Lung cancer screening has the potential to save many lives. In fact, it's estimated that lung cancer screening (for those who meet the screening criteria) could reduce lung cancer deaths by 20 percent. Since lung cancer is the leading cause of cancer deaths in both men and women in the United States, this translates to a very large number of people whose lives could be saved.

But, as with most cancer screening tests, there is the potential of finding abnormalities that turn out later to be nothing; what many people speak of as a "scare." This article carries tips for coping during that "scare" time you may face, whether your results mean nothing or mean cancer.

False Positives and Inconclusive Results With Lung Cancer Screening  

Studies tell us that false positive results occur in 20 to 50 percent of people who have CT lung cancer screening. Thankfully, a recent study found that people who had abnormal findings on their screening test did not experience any more anxiety or reduced quality of life when compared to people who were found to be cancer free. Yet, as with most studies, these are statistics, and people aren't statistics. If you are experiencing anxiety, fear, vulnerability, or isolation, you aren't alone. It's my hope that these tips on coping can help you face what comes next.

But first, what might you hear when your screen is abnormal? 

Some of the confusing words you may hear, or read on your radiology report, include:

  • Indeterminate
  • Inconclusive
  • Unclear
  • Equivocal
  • Questionable
  • Suspicious
  • Incidental
  • Abnormal

In addition to the words above, you may hear that you have a "shadow" a "nodule" a "tumor" or a "mass." This doesn't necessarily mean you have lung cancer as there are many causes of these findings.

One distinction may help as you learn about your screening abnormality. A nodule is defined as a "spot" or abnormality that is less than 3 cm (1 ½ inches) in diameter. A lung mass is defined as a spot that is greater than 3 cm in diameter. A tumor can be a spot of any size and can be benign (non-cancerous) or malignant (cancerous.)

There are many causes of abnormalities on lung CT scans - especially in people who have smoked, been exposed to cancer-causing substances in the environment such as radon or asbestos, or have a history of tuberculosis, that make interpreting lung CT scans a challenge for radiologists.

Ways to Cope When Your Lung Cancer Screening is Abnormal

What does worry accomplish? Nothing. But saying “don’t worry” is much easier said than done. What can you do to reduce your stress and anxiety when you hear your test is abnormal?

Try distraction - Think of things you do that demand your full concentration.

Can you think of activities in which you immerse yourself and forget about the time? Is it playing the piano? Painting? Washing windows? Surfing the Web? Playing monopoly or a video game? Take a few minutes to brainstorm about your passions and interests.

Remind yourself that knowledge is power - Familiarize yourself with lung cancer screening and the risks and causes of false positives and negatives. Knowing that abnormal results are extremely common - 20 to 50 percent - and that most end up being okay is a start. Most radiology centers are very good at educating people so they are aware of this risk. Keep in mind that many people will need additional testing to evaluate the results of their scan, and even with this additional testing, your results could very well be negative for cancer.

Ask a lot of questions - Ask your doctor to explain what exactly she means by abnormal. What is the next step she recommends?  Asking about "plan B" may also help you feel more in control. For example, based on the follow-up test she recommends, what will be the next step if the test is positive, negative or inconclusive? Sometimes there is more than one approach to follow up an abnormal result and you may feel confused as how to proceed. Some people find it helpful to ask their doctor or radiologist what they would do given the same scenario.

Write in a journal - When you are feeling anxious, writing down your fears and worries may help you sort out exactly what is worrying you. If you are worried that your abnormality is cancer you may be subconsciously thinking about how it would affect your health, your family, your finances, your dreams for the future. Writing down your thoughts not only clarifies your thoughts but may serve to make your worries more objective than subjective. 

Benefits of Journaling for Stress Management  

Talk to others who have “been there” - Talking to other people who have faced additional testing due to an abnormal lung cancer screening test may be helpful when you are feeling alone with your results. Your clinic may be able to recommend a local support group. Otherwise, there are several online support groups and chat rooms among the lung cancer community, where you can connect with others facing a similar concern. If you are unable to find someone who has faced an abnormal lung screening test -- after all, lung cancer screening is a fairly new test -- consider talking to someone who has had an abnormal mammogram or prostate screening test.  

Take a lesson from the “East" - Mind-body therapies are being increasingly recognized for their role in reducing stress. Examples include meditation, breathing exercises, and guided imagery/visualization.

Go outdoors - Whether it is taking a walk, gardening, or sitting on a beach, getting outside and communing with nature not only serves as a distraction, but many people find these activities calm their minds and renew their energy.

Exercise - Some people, but not all, find that moderate to strenuous exercise is a great stress reliever.

Reframe your thoughts - There is often more than one way to look at a situation.  Reframing isn't meant to downplay or discredit your fears. If you have an abnormal CT scan your fears are very real. Rather, it is a way to temporarily look at your situation in a different light.  An example I used was when I was bald from chemotherapy. On a hot summer day, while my friends were sweating, I simply removed my hair (wig) to cool down.  

Consider that anxiety is not always bad - If you are feeling anxious, keep in mind that some anxiety is helpful. Having some degree of anxiety motivates us to take measures to preserve or improve our health.   

Add a dose of humor - While you wait for results, humor can lighten your load. Consider renting funny movies. When friends ask what they can do, have them send funny emails. Certainly, there is a time to be serious when you are told your scan is abnormal, but a little humor may be good medicine while you wait.

Get enough sleepPeople who are stressed tend to get less sleep, and sleep deprivation only worsens anxiety. Check out these tips on getting quality sleep when stressed.

Ask yourself, "what's the worst thing that could happen?" - Growing up, when I felt anxious, my mother always told me to think about the worst thing that could happen as a way to relieve stress.  Certainly, with screening, there is the real fear that you could have cancer.. But sometimes even considering a diagnosis of cancer is easier than living with uncertainty. When you have a diagnosis you can research and create a plan of action. This isn't so when you have an "inconclusive" diagnosis.

Remind yourself of the benefits of screening - It may help to think of the lifesaving benefits of screening.  Ella A. Kazerooni, MD, chair of the American College of Radiology Lung Screening Committee stated this well, "It is clear that the lifesaving benefits of these exams in high-risk patients far outweighs any downside." To put the benefit of lung cancer screening in perspective further, it is considered as cost effective as screening tests for colon and breast cancer, and more cost effective than the use of seat belts and ​the presence of airbags in cars!

Note that there's a bonus if you smoke - We often talk about risks and false positives, but for people who smoke there may be a benefit of screening beyond early detection of cancer. People who smoke who undergo lung cancer screening are more likely to kick the habit than those who smoke and do not have lung cancer screening.

The Future of Lung Cancer Screening

Radiologists are actively looking into ways to reduce false positive lung cancer screening exams, and as more people undergo screening via the new recommendations, it's expected that the incidence of false positives will decrease. Radiologists and referring physicians are also taking a much more active role in educating people prior to the exam.

Sources

American College of Radiology. ACR Statement on Cancer Study Regarding Patient Anxiety From CT Lung Cancer Screening. 97/25/14. http://www.acr.org/about-us/Media-center/press-releases/2014-press-releases/20140725-acr-statement-on-cancer-study-regarding-patient-anxiety-from-ct-lung-cancer-screening

Gareen, I., et al. Impact of lung cancer screening results on participant health-related quality of life and state of anxiety in the National Lung Screening Trial. Cancer. July 25, 2014. Epub ahead of print.

National Cancer Institute. Lung Cancer Screening. 11/12/12. https://www.cancer.gov/cancertopics/pdq/screening/lung/Patient/page3

U.S. Preventive Task Force. Lung Cancer Screening. Recommendation Statement. Accessed 07/30/14. https://www.uspreventiveservicestaskforce.org/3rduspstf/lungcancer/lungcanrs.htm">http://www.uspreventiveservicestaskforce.org/3rduspstf/lungcancer/lungcanrs.htm

van den Bergh, K. et al. Long-term effects of lung cancer computed tomography screening on health-related quality of life. European Respiratory Journal. 2011. 38(1):154-61.

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