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Chapter 13: Lung Cancer

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A 62-year-old man who quit smoking 10 years ago comes to clinic asking, “Should I undergo screening for lung cancer?” His past medical history is significant for hypertension and chronic obstructive pulmonary disease. His social history is significant for a 30-pack year history of smoking and drinks a beer or two a day. Which of the following represent appropriate lung ­cancer screening recommendations for this patient?

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a. Annual chest x-ray

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b. Annual sputum cytology

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c. Annual helical CT scan

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d. Enrollment in a clinical trial of lung cancer screening

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Answer C is correct. The NLST showed that in patients aged 55-74 with at least a 30-pack year smoking history annual low-dose helical CT scan decreases lung cancer related mortality by 20% compared to annual chest x-ray. Guidelines have been adopted based on these findings.

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Answer a is incorrect. Randomized trials have not demonstrated that chest x-rays either every 6 months or annually reduce mortality associated with lung cancer.

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Answer b is incorrect. Randomized trials have not demonstrated that sputum cytology reduce the mortality associated with lung cancer.

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Answer d is incorrect. This patient meets the criteria from the NLST. In patients who do not meet NLST criteria, participation in a clinical trial may be warranted.

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A 60-year-old woman comes into your pharmacy to pick up her prescription for hydrochlorothiazide for hypertension. She asks you about taking vitamin supplements to decrease her risk of lung cancer. Her social history is signi­ficant for smoking a pack of cigarettes a day for 25 years, but she stopped a year ago. Based upon this information, you should recommend which of the following.

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a. No supplement is recommended

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b. β-Carotene

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c. Vitamin E plus β-carotene

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d. β-Carotene plus retinyl palmitate

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Answer a is correct. To date, randomized trials of chemopreventive agents (eg, vitamin E, β-carotene, and retinyl palmitate) have not demonstrated a benefit in preventing lung cancer in patients at high risk for developing lung cancer. In two randomized clinical trials, β-carotene has been associated with an increased risk of lung cancer and mortality in patients at high risk for developing lung cancer.

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Answer b is incorrect. In two randomized clinical trials, β-carotene has been associated with an increased risk of lung cancer and mortality in patients at high risk for developing lung cancer.

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Answer c is incorrect. In two randomized clinical trials, β-carotene has been associated with an increased risk ...

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