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Commentary |

What to Do When a Smoker’s CT Scan Is “Normal”?CT Scan and Lung Cancer: Implications for Lung Cancer Screening

Joanna H. Zurawska, MD; Rachel Jen, MD; Stephen Lam, MD, FCCP; Harvey O. Coxson, PhD; Jonathon Leipsic, MD; Don D. Sin, MD, FCCP
Author and Funding Information

From the Department of Medicine, Division of Respiratory Medicine (Drs Zurawska, Jen, Lam, and Sin); the Department of Radiology (Drs Coxson and Leipsic), University of British Columbia; the UBC James Hogg Research Center (Drs Coxson and Sin), and the Institute of Heart and Lung Health (Drs Coxson and Sin), St. Paul’s Hospital, University of British Columbia; and the Imaging Unit (Dr Lam), Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada.

Correspondence to: Don D. Sin, MD, FCCP, St. Paul’s Hospital, University of British Columbia, Room 8442, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada; e-mail: don.sin@hli.ubc.ca


Funding/Support: Dr Coxson is supported in part by the University of Pittsburgh COPD Specialized Centers of Clinically Oriented Research and the National Heart, Lung, and Blood Institute, National Institutes of Health [Grants 1P50 HL084948 and R01 HL085096] to the University of Pittsburgh. Dr Sin is supported by a Canada Research Chair Award in COPD, University of British Columbia.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1147-1152. doi:10.1378/chest.11-1863
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Lung cancer is the leading cause of cancer-related mortality in the United States and around the world. There are > 90 million current and ex-smokers in the United States who are at increased risk of lung cancer. The published data from the National Lung Screening Trial (NLST) suggest that yearly screening with low-dose thoracic CT scan in heavy smokers can reduce lung cancer mortality by 20% and all-cause mortality by 7%. However, to implement this program nationwide using the NLST inclusion and exclusion criteria would be extremely expensive, with CT scan costs alone > $2 billion per annum. In this article, we offer a possible low-cost strategy to risk-stratify smokers on the basis of spirometry measurements and emphysema scoring by radiologists on CT scans.

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