From the Guidelines
The most appropriate study to recommend to this 70-year-old retired pilot is a low-dose CT scan of the chest (option B). This recommendation is based on the latest guidelines from the NCCN, which suggest that individuals with a history of smoking, regardless of the time since quitting, are at high risk for lung cancer 1. Although the patient's pack-year history is below the typical threshold, his age and history of smoking make low-dose CT screening reasonable. The NCCN guidelines recommend annual lung cancer screening with low-dose CT for adults aged 50-80 who have a 20 pack-year smoking history, and the panel does not include time since quitting smoking as an eligibility criterion for lung cancer screening 1.
Some may argue that the patient's pack-year history is below the typical threshold, but the NCCN guidelines suggest that expanding screening beyond the NLST criteria to a larger group of individuals at risk for lung cancer may save thousands of additional lives 1. The other options are less appropriate:
- Bone densitometry is typically recommended for women over 65 or men over 70 with risk factors beyond what's presented, such as a family history of osteoporosis or a personal history of fractures.
- Spirometry would be indicated for persistent respiratory symptoms, which are not present in this patient.
- A stress test isn't indicated without cardiac symptoms or high cardiovascular risk, and the patient's history of hypertension and hyperlipidemia is being managed with medication.
- Abdominal ultrasonography isn't supported by his clinical presentation, as there are no symptoms or risk factors for abdominal disease.
Early detection of lung cancer through screening can significantly improve outcomes in appropriate candidates, and the latest evidence suggests that low-dose CT screening is effective in reducing lung cancer deaths in high-risk individuals 1. Therefore, low-dose CT scan of the chest (option B) is the most appropriate study to recommend to this patient.
From the Research
Patient Profile
The patient is a 70-year-old retired pilot with a history of hypertension and hyperlipidemia, and a 10 pack-year history of cigarette smoking, which he quit 30 years ago.
Relevant Studies
- The National Lung Screening Trial demonstrated the efficacy of low-dose CT screening in reducing lung cancer mortality in a high-risk population 2.
- A study published in the European journal of radiology found that coronary artery calcifications (CAC) evaluated in low-dose computed tomography (LDCT) for lung cancer screening are associated with cardiovascular mortality 3.
- The US Preventive Services Task Force (USPSTF) recommends low-dose computed tomographic (CT) screening for high-risk current and former smokers with a B recommendation 4.
Recommended Study
Based on the patient's history of smoking and age, the most appropriate study to recommend is:
- B. low-dose CT scan of the chest, as it can help detect lung cancer and coronary artery calcifications, which are associated with cardiovascular mortality 3, 2, 5, 6.
Key Considerations
- The patient's 10 pack-year history of cigarette smoking and age make him a candidate for low-dose CT screening 4, 5.
- The study by 5 found that low-dose CT screening reduces lung cancer mortality and can be delivered efficiently to an ethnically and socioeconomically diverse population.
- The patient's history of hypertension and hyperlipidemia also increase his risk for cardiovascular disease, making the detection of coronary artery calcifications important 3.