Prevention, Screening & Health Maintenance
Family Medicine Clerkship

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Lung Cancer
 

Who are high-risk individuals for developing lung cancer?

• Smokers over the age of 50

Which imaging procedures are considered in early detection of lung cancer?

• CXR
• Low dose spiral CT

What is the current role of CXR as a screening test for early detection of cancer lung?

• Studies have proven that CXR as a screening test does not have any survival advantage and is no longer recommended.

What is the current role of spiral CT as a screening test for early detection of cancer lung?

• Sensitivity
  • CT is more sensitive than conventional chest radiography for the detection of lung nodules
• Specificity
  • Most of the nodules are benign.
  • Some of these nodules prove to be lung cancer.

What factors contribute to the cost for screening high-risk patients?

• Factors that contribute to the cost of the screening program include:
  • Number of potential candidates for screening
  • Cost of spiral CT
  • Annual screening

Most of the nodules detected by spiral CT are benign.  What is the morbidity and harm to patients resulting from investigations of these non specific lesions?

Patients with such nodules need further workup, which can be costly and nerve racking to prove they are benign. Possible issues include:

• Unnecessary anxiety
• Expensive follow up evaluations
• Mortality and morbidity from procedures

How is early detection advantageous?

• CT detects more cases of lung cancer.
• More patients screened by CT have resectable early-stage disease.

What are the limitations of cancer screening?

• Aggressive tumors are not benefited by detection in the screening procedure.
• There is no proven benefit for early detection of slow growing tumors.
• There is no proven survival benefit.

What are the current recommendations for lung cancer screening?

• Several studies are being conducted to identify any benefit of a screening CT.
• Current recommendations do not call for lung cancer screening of either the general population or of smokers.

Required Images

• CXR
  • Non specific nodule
  • Specific nodules
    
     
• Spiral CT
  • Multiple nodules
  • Non specific nodules
  • Specific nodules