Less than 1 in 1000 patients with a false-positive result experience a major complication resulting from diagnostic workup.
Counsel all patients against tobacco use, no matter their age. Smokers who quit gain ∼10 y of increased life expectancy and have maximum reduction in risk of lung cancer after 15 y of no tobacco use. (Br Med J. 2004:328)
Spiral CT screening can detect greater number of lung cancers in smokers with a >10-pack-year exposure. (N Engl J Med. 2006;355:1763-1771)
The NCI has reported data from the National Lung Screening Trial (NLST), a randomized controlled trial comparing LDCT and CXR yearly × 3 with 8-y follow-up. A total of 53,500 men and women age 50–74 y, 30 pack-year smokers were randomized. A 20.3% reduction in deaths from lung cancer was reported for the LDCT group (estimated that 10,000–15,000 lives could be saved per year). Problems with false-positives (25% have lung nodules <1 cm that are not cancer) and cost of workup were noted, but benefits have led to a change in guidelines.
The ACCP, ACS, NCCN, and ASCO formally recommend LDCT screening for patients who meet the criteria of the NLST study. (It is estimated that 8.6 million Americans meet NLST criteria for screening, ...