A 59-year-old man is evaluated during a health maintenance visit. He is asymptomatic. He has a 35-pack-year smoking history, but he quit smoking 5 years ago. He takes no medications.
Vital signs and the results of the physical examination are normal.
Which of the following is the most appropriate screening test to obtain?
Answer: C - Low-dose chest CT
Objective: Screen for lung cancer in a former smoker.
Screening for lung cancer with annual low-dose chest CT is recommended for high-risk patients, defined as adults aged 55 to 80 years with a smoking history of 30-pack-years or more, including former smokers who have quit in the last 15 years.
In patients who are at high risk for lung cancer, annual low-dose CT is recommended to screen for lung cancer. High-risk patients are adults aged 55 to 80 years with a 30-pack-year or more smoking history, including former smokers who have quit in the last 15 years. Candidates for screening should have a reasonable life expectancy and be willing to undergo curative lung surgery. The U.S. Preventive Services Task Force (USPSTF) recommends that screening be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the willingness to have curative lung surgery. A large randomized controlled trial, the National Lung Screening Trial (NLST), found a 20% reduction in lung cancer mortality in patients who were screened with low-dose CT compared with those screened with chest radiography. The number of high-risk patients needed to screen with low-dose CT to prevent one lung cancer death was 320. Potential harms related to screening include a high false-positive rate, radiation exposure, potential for discovering incidental findings, risks associated with follow-up, and overdiagnosis. Twenty-four percent of those screened with low-dose CT had a positive screening, and 96% of those cases were false-positive results.
The greatest risk factors for the development of abdominal aortic aneurysm (AAA) are age, male sex (men outnumber women by up to 6:1), and a history of smoking. The USPSTF recommends one-time screening for AAA with abdominal ultrasonography in all men aged 65 to 75 years who have smoked at least 100 cigarettes in their lifetime and selective screening in men in this age group who have never smoked. Men in this category might include those with a first-degree relative who required repair of an AAA or died of a ruptured AAA. This patient should be screened for AAA when he is 65 years of age.
Plain chest radiography is not recommended to screen for lung cancer in any population.
Routine spirometry is not recommended in asymptomatic individuals, including asymptomatic smokers, to screen for chronic obstructive lung disease.
National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. Link Out