title: What to do when a smoker's CT scan is "normal"?: Implications for lung cancer screening.
abstract: 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.
authors.affiliation: Department of Medicine, Division of Respiratory Medicine, University of British Columbia, BC, Canada.
authors.forename: Joanna H
authors.initials: JH
authors.lastname: Zurawska
authors.affiliation: Department of Medicine, Division of Respiratory Medicine, University of British Columbia, BC, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jen
authors.affiliation: Department of Medicine, Division of Respiratory Medicine, University of British Columbia, BC, Canada; Imaging Unit, Integrative Oncology, British Columbia Cancer Research Centre, Vancouver, BC, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lam
authors.affiliation: Department of Radiology, University of British Columbia, BC, Canada; UBC James Hogg Research Center, University of British Columbia, BC, Canada; Institute of Heart and Lung Health, St. Paul's Hospital, University of British Columbia, BC, Canada.
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.affiliation: Department of Radiology, University of British Columbia, BC, Canada.
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.affiliation: Department of Medicine, Division of Respiratory Medicine, University of British Columbia, BC, Canada; UBC James Hogg Research Center, University of British Columbia, BC, Canada; Institute of Heart and Lung Health, St. Paul's Hospital, University of British Columbia, BC, Canada. Electronic address: don.sin@hli.ubc.ca.
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
mesh_terms: D000368:Aged; D000465:Algorithms; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D003362:Cost-Benefit Analysis; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics / Q000209:etiology / Q000401:mortality; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D011237:Predictive Value of Tests; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000191:economics / Q000209:etiology / Q000401:mortality; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality; D013147:Spirometry / Q000191:economics; D014057:Tomography, X-Ray Computed / Q000191:economics