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Point and Counterpoint |

COUNTERPOINT: Are There Cases in Which Physicians Should Deviate From Recommendations Not to Order a Chest CT Scan? NoDeviation From Recommendations on CT Scan? No

Tamara Simpson, MD
Author and Funding Information

From the Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center at San Antonio.

CORRESPONDENCE TO: Tamara Simpson, MD, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Health Science Center at San Antonio, 7400 Merton Minter Blvd, 111E, San Antonio, TX 78229; e-mail: simpsont2@uthscsa.edu


FINANCIAL/NONFINANCIAL DISCLOSURES: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(5):1147-1149. doi:10.1378/chest.14-1587
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A 54-year-old patient, former smoker (25 pack-year history, quit 10 years ago) states, “Doc, I know it is outside the guidelines. But I am worrying all the time that the residual scar from my pneumonia last year might be a lung cancer. And I am willing to pay cash for the study.” Should a chest CT scan be ordered with the diagnosis of abnormal chest radiograph?

This patient indeed has valid concerns. Lung cancer is the leading cause of cancer death in the United States, and smoking is associated with 85% of all lung cancer cases.1 In addition, lung cancer mortality is related to its stage at diagnosis, but only 15% of cases are diagnosed at early stages.2 Although lung cancer screening has been researched for many years, no screening test showed significant mortality benefit until the National Lung Screening Trial (NLST) published its results in 2011.3 The NLST concluded that annual screening with low-dose CT (LDCT) scanning in current and former smokers (cessation within prior 15 years), aged 55 to 74 years, with 30 pack-years leads to a reduction in lung cancer mortality of 16% and a reduction in all-cause mortality of 6.7%.4 Many professional organizations, including the American College of Chest Physicians (CHEST), the American Thoracic Society, the American Cancer Society, and the American Association for Thoracic Surgery, have since begun recommending annual LDCT scan screening.5 In addition, the US Preventive Services Task Force (USPSTF) recently published its final recommendation in favor of screening.5 However, all are in agreement that prevention of lung cancer through smoking cessation continues to be the best and most cost-effective strategy to decrease lung cancer mortality.5 Despite these recommendations for screening patients for lung cancer using LDCT scanning, most experts agree there are also concerns regarding the implementation of such programs.

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