What to do when a smoker's CT scan is "normal"?: Implications for lung cancer screening

Chest. 2012 May;141(5):1147-1152. doi: 10.1378/chest.11-1863.

Abstract

Lung cancer is the leading cause of cancer-related mortality in the United States and around the world. There are > 90 million current and ex-smokers in the United States who are at increased risk of lung cancer. The published data from the National Lung Screening Trial (NLST) suggest that yearly screening with low-dose thoracic CT scan in heavy smokers can reduce lung cancer mortality by 20% and all-cause mortality by 7%. However, to implement this program nationwide using the NLST inclusion and exclusion criteria would be extremely expensive, with CT scan costs alone > $2 billion per annum. In this article, we offer a possible low-cost strategy to risk-stratify smokers on the basis of spirometry measurements and emphysema scoring by radiologists on CT scans.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Algorithms
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
  • Carcinoma, Non-Small-Cell Lung / economics
  • Carcinoma, Non-Small-Cell Lung / etiology
  • Carcinoma, Non-Small-Cell Lung / mortality
  • Cause of Death
  • Cost-Benefit Analysis
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / economics
  • Lung Neoplasms / etiology
  • Lung Neoplasms / mortality
  • Male
  • Mass Screening* / economics
  • Middle Aged
  • Predictive Value of Tests
  • Pulmonary Emphysema / diagnostic imaging
  • Pulmonary Emphysema / economics
  • Pulmonary Emphysema / etiology
  • Pulmonary Emphysema / mortality
  • Smoking / adverse effects*
  • Smoking / mortality
  • Spirometry* / economics
  • Tomography, X-Ray Computed* / economics