So let’s move on to our bonus cancer
screening, which is lung cancer.
And boy, this is like the
white whale of cancer
screening because we know
how deadly lung cancer is.
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.
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.
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.
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.
So 30 pack-years, if I was
one pack a day smoker and
I’ve been doing it for
30 years, 30 pack-years.
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.
Does that make sense?
It does to me.
And also, it’s important
that patients who are either
current smokers or quit
smoking in the past 15 years.
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.
So I think there are
some criticisms here and
just areas of controversy
to be aware of.
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.
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.
That adds to cause and
also adds to accumulative
dose of radiation these
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.
But still, lung cancer being such a
killer, it’s certainly worth considering
following the recommendations from
the Preventive Services Task Force.
And so that ends our section
on cancer screening.
It’s critically important we, you
know, we in family medicine really
do more than just treat disease,
we’re trying to maintain wellness.
Cancer screening is an important part of
that and hopefully you embrace it too.