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Beyond the Guidelines |

Screening for Lung Cancer With Low-Dose Computed Tomography: Grand Rounds Discussion From the Beth Israel Deaconess Medical CenterScreening for Lung Cancer With LDCT

Gerald W. Smetana, MD; Phillip M. Boiselle, MD; and Richard M. Schwartzstein, MD
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Author Biographies

Dr. Smetana is a member of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Professor of Medicine at Harvard Medical School, both in Boston, Massachusetts.

Dr. Boiselle is a member of the Department of Radiology at Beth Israel Deaconess Medical Center, and Associate Dean for Academic and Clinical Affairs and a Professor of Radiology at Harvard Medical School, both in Boston, Massachusetts.

Dr. Schwartzstein is a member of the Department of Medicine at Beth Israel Deaconess Medical Center, and Director of the Academy and Professor of Medicine at Harvard Medical School, both in Boston, Massachusetts.

Acknowledgment: The authors thank the patient for sharing her story.

Grant Support: Beyond the Guidelines receives no external support.

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0055.

Requests for Single Reprints: Gerald W. Smetana, MD, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, gsmetana@bidmc.harvard.edu.

Current Author Addresses: Dr. Smetana: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

Dr. Boiselle: Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.

Dr. Schwartzstein: Center for Education, Shapiro Institute, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.


Ann Intern Med. 2015;162(8):577-582. doi:10.7326/M15-0055
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In December 2013, the U.S. Preventive Services Task Force recommended screening for lung cancer with low-dose computed tomography (LDCT) for selected current and former smokers. The Task Force based the recommendation primarily on the results of the NLST (National Lung Screening Trial). In this trial, patients randomly assigned to LDCT screening for 3 years had lower rates of both lung cancer–specific mortality and all-cause mortality (relative risk reduction, 6.7% [95% CI, 1.2% to 13.6%]; absolute risk reduction, 0.46% [CI, 0% to 0.9%]). Clinicians and health systems confront questions and challenges as they begin to implement lung cancer screening. This paper summarizes a conference during which an internist and a radiologist discuss the application of the Task Force recommendation to an individual patient.

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Comments

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Comment
Posted on May 5, 2015
Alejandro Millan Mon, MD
Hospital Provincial de Pontevedra
Conflict of Interest: None Declared

In “Beyond the guidelines: What would you do?”, the patient, Ms. D, is being treated with
albuterol, fluticasone, ipratropium / albuterol, atenolol, atorvastatin, bupropion, clopidogrel,
diazepam, gabapentin, glipizide, losartan, metformin, trazodone, and warfarin.
I think that it may be appropiate to order a CT scan to screen the patient for lung cancer. But,
definitely, I would change her treatment. I would stop trazodone in days, stop gabapentine in weeks
and inmediately change diazepam for a shorter benzodiacepine. Besides, I doubt if she is really
benefitting from atenolol.

Alejandro Millan Mon MD

Hospital Provincial de Pontevedra
legal aspects of screening
Posted on May 16, 2015
Linda L. Isaacs MD
private practice
Conflict of Interest: None Declared
It was not clear to me in this article whether Dr. Schwartzstein would discuss screening with this patient and advise against it, or whether he would not bring it up. Also, there was no discussion of the possible legal implications of failing to screen. A family member of mine died of unresectable lung cancer in 2007, well before the publication of the NLST results. She was extremely angry that she had never been screened for lung cancer and found a lawyer willing to represent her in a suit against her pulmonologist, who had managed her COPD for 20 years. I seriously doubt whether her pulmonary status was good enough for resection. Nonetheless, an attorney was willing to move forward. She passed away before any action was taken and her daughter opted not to pursue the matter. Reading about Ms. D, I wonder if she or others like her would be inclined to seek legal representation, and how the authors would suggest approaching documentation of the discussion about screening or the decision by the physician not to screen.
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