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Lung Cancer

by Charles Vega, MD
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    00:00 So let’s move on to our bonus cancer screening, which is lung cancer.

    00:05 And boy, this is like the white whale of cancer screening because we know how deadly lung cancer is.

    00:12 For years, it’s been the number one cancer killer in the United States, 200,000 cases of lung cancer in the US in 2010, the majority of which were fatal, and tobacco is of course implicated in the majority of cases of lung cancer.

    00:27 And so, after trying for many years from using different modalities, it was really this National Lung Screening Trial which demonstrated a positive result in terms of being able to prevent a lung cancer death using low-dose CT screening with a number needed to screen of 312, it moderately elevated, to prevent one lung cancer death in five years.

    00:54 So what is the new recommendation from the United States Preventive Services Task Force called for? Annual low-dose CT screening between the ages of 55 to 80 years if the patient meets a couple of criteria.

    01:07 There’s at least a 30 pack-year smoking history, and for those who don’t know what a pack-year is, multiply the number of packs per day times the number of years smoking.

    01:16 So 30 pack-years, if I was one pack a day smoker and I’ve been doing it for 30 years, 30 pack-years.

    01:23 If I was a half a pack a day smoker but I’ve been doing it for 60 years, 60 pack-years -- or I’m sorry, 30 pack-years again.

    01:29 Does that make sense? It does to me.

    01:33 And also, it’s important that patients who are either current smokers or quit smoking in the past 15 years.

    01:40 So some of you quit 25 years ago, not only is their risk of COPD a lot lower after quitting so long ago, so is their risk of cancer.

    01:51 So I think there are some criticisms here and just areas of controversy to be aware of.

    01:57 That trial, the National Lung Screening Trial, was performed at large academic centers, so our community radiology practice is going to be able to, you know, with nuance, be able to interpret those many CT scans that are coming in to them, particularly in areas where there are a lot of smoking.

    02:15 The rates of false-positive studies as you can imagine, this is chronic smokers and their lungs on CT, boy, that’s a potent combination for a lot of fibrosis, granulomas, abnormal findings, so the rate of recall for these patients is fairly high.

    02:32 That adds to cause and also adds to accumulative dose of radiation these patients receive.

    02:36 These are things to consider and you may want to talk to your patients about the fact that they may have some findings and they will need repeat screening on a sooner interval than an annual basis.

    02:49 But still, lung cancer being such a killer, it’s certainly worth considering following the recommendations from the Preventive Services Task Force.

    02:59 And so that ends our section on cancer screening.

    03:01 It’s critically important we, you know, we in family medicine really do more than just treat disease, we’re trying to maintain wellness.

    03:10 Cancer screening is an important part of that and hopefully you embrace it too.

    03:13 Thanks.


    About the Lecture

    The lecture Lung Cancer by Charles Vega, MD is from the course Preventive Medicine.


    Included Quiz Questions

    1. 55 years
    2. 40 years
    3. 45 years
    4. 50 years
    5. 60 years
    1. Lung cancer
    2. Prostate cancer
    3. Breast cancer
    4. Colon cancer
    5. Cervical cancer
    1. Low dose CT scan
    2. High dose CT scan
    3. Low dose MRI
    4. High dose MRI
    5. X-ray

    Author of lecture Lung Cancer

     Charles Vega, MD

    Charles Vega, MD


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