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Chest. 2012 May;141(5):1147-52. doi: 10.1378/chest.11-1863.

What to do when a smoker's CT scan is "normal"?: Implications for lung cancer screening.

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  • 1Department of Medicine, Division of Respiratory Medicine, University of British Columbia, BC, Canada.


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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