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Teachable Moment
Less Is More
August 2017

Maximizing Benefits and Minimizing Harms of Lung Cancer Screening: A Teachable Moment

Author Affiliations
  • 1Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
JAMA Intern Med. 2017;177(8):1197-1198. doi:10.1001/jamainternmed.2017.2349

A woman in her 50s contacted her physician to request low-dose computed tomography (LDCT) for lung cancer screening (LCS). The patient had a 10–pack-year smoking history, had quit smoking 20 years previously, and had a calculated 5-year lung cancer risk of less than 0.2% by the Brock risk prediction model.1 The LDCT scan revealed scattered subcentimeter lung nodules for which follow-up imaging was recommended. Follow-up LDCT 3 months later demonstrated stability of the previously identified nodules but a new 3.2-cm right lower lobe lesion. Subsequent positron emission tomography revealed an intensely fludeoxyglucose-avid right lower lobe mass but no other concerning areas. On this basis, the patient was referred for surgical resection of a presumed lung cancer. Because this lesion had a calculated volume doubling time (VDT) of less than 7 days and the patient was otherwise at low risk for developing lung cancer, surgical consideration was deferred. One month later, LDCT revealed a decrease in the size of this lesion, consistent with a resolving inflammatory or infectious process.

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