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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, firstname.lastname@example.org.
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.
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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