8 Medical Tests Every Smoker Needs

If you’re a current or former smoker, learn which important medical tests — including lung tests — you should discuss with your doctor.

There’s no way around it: If you smoke, you’re more likely to develop many serious conditions, from cancer and lung disease to heart disease and diabetes.

That’s why doctors say you’ll need to get certain screenings and lab tests more frequently than nonsmokers.

Let your doctor know if you're a current or former smoker. And ask them to look for warning signs of smoking-related diseases during checkups, says the pulmonary (lung) specialist Neil Schachter, MD, a professor of medicine at Mount Sinai Medical Center in New York City.

Here are eight tests current or former smokers may need, and how often to get them.

1. Medical Tests for Smokers: Spirometry

Every smoker should undergo a spirometry test, says Dr. Schachter.

Spirometry is a simple and inexpensive breathing test — done in a doctor’s office and lab — that measures how well your lungs work. It’s the best lung test for diagnosing early-stage chronic obstructive pulmonary disease (COPD), a progressive lung disease caused mainly by smoking.

“You just blow into the machine [for 6 seconds] and it shows the amount of air that goes into your lungs, and how it comes out,” says Zab Mosenifar, MD, the medical director of the Women’s Guild Lung Institute at Cedars-Sinai Medical Center in Los Angeles.

Typically, you’ll perform the test three times in a row — breathing out as hard as you can into the spirometry tube. Your doctor will look for consistent results and use the highest value as the final result.

“It’s good for seeing how much [lung] damage has already been done,” Dr. Mosenifar says.

Schachter recommends spirometry at annual checkups — or anytime you visit the doctor for respiratory problems.

Poor lung function may lead to other health issues. For example, “If [you need] surgery, you have a greatly increased risk of post-operative complications,” Dr. Fuller says.

If you continue to smoke, your lung function and capacity will get worse over time. But as soon as you stop smoking, some — though not all — of the damage will begin to heal, he says.

2. Medical Tests for Smokers: Chest X-Ray

Some doctors recommend yearly chest X-rays for all patients who smoke tobacco.

“X-ray screening is the minimal test we should do in smokers or ex-smokers,” Schachter says.

That’s because they can show heart and blood vessel problems that can be made worse by smoking. X-rays also help physicians look for blocked arteries or other heart conditions and act quickly to prevent complications, he says.

Plus, they can detect cancer-related abnormalities.

Chest X-rays, however, aren’t as effective in finding early-stage lung cancers, according to a 2011 National Cancer Institute landmark study published in the Journal of the American Medical Association (JAMA).

Many doctors prefer CT scans for that purpose, Schachter says.

3. Medical Tests for Smokers: CT Scans

Low-dose computed tomography, or CT scan, is a highly recommended test for smokers. CT scans provide better diagnostic images than X-rays. These better images allow doctors to detect problems, such as lung cancer, in earlier stages. Early lung cancer diagnosis saves lives because surgery is often still possible in the early stages, Schachter says.

“By the time they’re found, 85 percent of lung cancers aren’t able to be treated surgically — and surgery is the best [treatment] we have for curing lung cancer,” Schachter explains.

People with stage 1 lung cancers have a 60 percent to 70 percent survival rate five years after surgery, he says. “Later stages only have 5 percent to 30 percent [survival rates].”

The U.S. Preventive Services Task Force recommends an annual CT scan if you’re 50 or older with a history of heavy smoking (at least 20 pack years), whether you still smoke or have quit within the past 15 years.

Check with your doctor about how often, Schachter says.

4. Medical Tests for Smokers: Electrocardiogram (ECG or EKG)

If you’re a longtime smoker, your doctor will probably do an electrocardiogram (also called ECG or EKG) during your annual checkup to detect heart disease.

An electrocardiogram measures the speed, rhythm, and regularity of your heartbeat. The results show if and where your heart is damaged.

If you smoke, you have a higher risk of developing heart disease.
That’s because smoking can cause life-threatening damage to your heart, including ventricular arrhythmia — in which the electrical impulses controlling the two lower heart chambers, or ventricles, become irregular, Schachter says.

Carbon monoxide in tobacco smoke “prevents oxygen from getting to your heart,” he explains. “That can cause the heart to malfunction.”

If you smoke, your risk of developing atherosclerosis — plaque buildup in the arteries — is high. This buildup makes your heart’s blood vessels more narrow, which blocks blood flow and increases your risk of heart attack and stroke.

If an ECG reveals problems, your doctor may recommend other medical tests, such as a cardiac stress test, which examines blood flow while you’re exercising.

5. Medical Tests for Smokers: Diabetes Screenings

Smokers are at risk of developing type 2 diabetes, a condition that causes problems with the way your body uses food for energy. If you have diabetes, your body doesn’t respond to or produce enough insulin — a hormone that helps sugar get into your cells for energy.

People who smoke are 30 to 40 percent more likely to develop type 2 diabetes than nonsmokers. The more you smoke, the higher your risk. And if you have diabetes and smoke, it’s more difficult to manage your condition.

Your doctor may recommend the following diabetes tests:

Fasting blood glucose level, which measures blood sugar when you haven’t eaten in eight hours
Oral glucose tolerance, which measures blood sugar levels after you drink a sugary liquid
Hemoglobin A1C (HbA1C), which shows average blood glucose levels over the past three months

Once you stop smoking, your risk of developing diabetes may decrease, But it will never go away entirely — especially if you’re overweight, Schachter says. That’s why he advises smokers to be screened for diabetes during their yearly physicals.

6. Medical Tests for Smokers: Vitamin D Blood Test and Screening for Osteoporosis

Vitamin D deficiency is a preventable and treatable condition that causes problems with your bones and muscles.
Among smokers, this deficiency can lead to reduced lung function and faster decline in lung health, according to an October 2012 study in the American Journal of Respiratory and Critical Care Medicine.

Vitamin D deficiency — defined as less than 20 nanograms per milliliter of blood — has been associated with many lung problems, Schachter says.

If you are a current or past smoker and have symptoms of low vitamin D, such as muscle weakness or bone pain, ask your doctor about getting a vitamin D blood test.
You can also get a bone density study to look for osteoporosis.

If you have low vitamin D levels, your doctor will recommend the best treatment for you, which might include diet changes, more sunlight, or a vitamin D supplement.

7. Medical Tests for Smokers: Oral and Throat Cancer Screening

Current and former smokers are at a 5 to 10 times higher risk for developing oral (mouth) and pharyngeal (throat) cancers. People who are 55 to 64 years old are even more at risk.

While there is no special screening to test for oral or throat cancers, your doctor will check your mouth during a routine checkup and look for abnormalities.

If your doctor finds any areas in your mouth or throat that don’t look right, they’ll recommend a procedure to examine these abnormal tissues more closely. This might include using a dye or stain to better see sores or scratches, or collecting cells that can be viewed under a microscope.

Be sure to tell your doctor if you have any sores in your mouth, especially if they don’t heal. Like other cancers, mouth or throat cancer that is found early may be easier to treat.

8. Medical Tests for Smokers: Kidney Function Test

If you smoke, you’re more likely to develop chronic kidney disease (CKD).
Your risk is even higher if you have diabetes or heart disease.
Often, there are no early symptoms of CKD, so getting screened is important to catch the disease early.

There are several tests used to measure kidney function. But the two most common to check for CKD are:

Estimated glomerular filtration rate (eGFR), which measures how well your kidneys are filtering your blood
Urine albumin-creatinine ratio (uACR), which measures the amount of protein and waste in your urine

The results of these tests give your doctor a clear picture of how well your kidneys work, and if you’re at risk of developing kidney disease. If your lab values show that your kidneys aren’t working well, your doctor will likely repeat the tests to confirm the results.

Your doctor will tell you how often you should have a kidney function test. But if you’re a current or former smoker and have diabetes, you should get tested annually.

Need Help?

If you’re ready to quit smoking, visit www.smokefree.gov for information and free resources, including a step-by-step guide to quitting. The National Cancer Institute offers free smoking cessation counseling from 8 a.m. to 8 p.m. ET, or 5 a.m. to 5 p.m. PT.

Your state’s free quit line, 800-QUIT-NOW (800-784-8669), also has specially trained, supportive phone counselors available.

The Takeaway

Early identification is key to treating smoking-related conditions such as cancer, diabetes, vitamin D deficiency, and heart, kidney, and lung diseases. If you’re a current or past smoker, ask your doctor about getting screened for these conditions. Medical tests for smokers may reveal problems early on leading to the best chance of a good outcome.

Additional reporting by Lori Newman.

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