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A 60-year-old man is evaluated during a routine examination. He has been attempting to quit smoking cigarettes for several months but has been unsuccessful despite numerous office-based counseling interventions, participation in smoking-cessation support groups, nicotine-replacement therapy, and bupropion therapy. His medical history is noncontributory, and his family history is unremarkable. The physical examination is normal.
Which of the following interventions is most likely to reduce this patient's risk of dying from lung cancer?
A Annual spiral CT
B Annual chest radiography
C Annual sputum cytology
D Encouragement of repeated smoking-cessation attempt
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D)
Key Point
Lung cancer screening does not decrease mortality and is not supported by evidence.
No evidence-based screening interventions for lung cancer exist; therefore, participation by this patient in a lung cancer screening program cannot be recommended. Instead, this patient should be encouraged to quit smoking once again, which is the only way to reduce his risk for lung cancer.
Most studies of spiral CT for lung cancer screening have generally only recruited current and former cigarette smokers and have not demonstrated decreased lung cancer mortality, although randomized trials are ongoing. Likewise, a decrease in lung cancer mortality has not been found in randomized studies of patients who were screened with chest radiography and sputum cytology. A randomized controlled trial of chest radiography and sputum cytology found that although these screening methods could detect early-stage lung cancer that is not potentially significantly lethal, they did not have an affect on lung cancer mortality. In a Japanese cohort study of spiral CT for lung cancer in smokers and never-smokers, the rates of lung cancer detected by spiral CT were similar in both groups, also suggesting the possibility of overdiagnosis.
