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Abdominal ultrasound
0%
0/4
Chest CT scan
25%
1/4
Pap smear
Colonoscopy
50%
2/4
Chest radiograph
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The patient presents between ages of 55 and 80 and has quit smoking within the last 15 years. She should undergo an annual low dose chest CT scan for lung cancer screening. Cigarette smoking is the leading cause of preventable death in the United States and significantly contributes to deaths from cancer along with cardiovascular and pulmonary diseases. Smoking not only harms adults, but also results in the deaths of about 1,000 infants annually. Moyer and the USPSTF report on the guidelines for lung cancer screening that have been recently implemented in the United States. They state that age, total cumulative exposure to tobacco smoke, and years since quitting smoking are the most important risk factors for lung cancer. They report that annual screening for lung cancer with low-dose CT in a defined population of high-risk persons can prevent a substantial number of lung cancer–related deaths as evidenced by large randomized controlled trials. Tammemagi et al. discuss the effect of lung cancer screening on smoking cessation. They state that when compared with those with a normal screen, individuals were less likely to be smokers if their previous year's screen had a major abnormality that was not suspicious for lung cancer (Odds Ratio or OR=0.811), was suspicious for lung cancer but stable from previous screens (OR=0.785), or was suspicious for lung cancer and was new or changed from the previous screen (OR=0.663). They also state that these differences in smoking prevalence were seen up to 5 years after the patients screening. Incorrect Answers: Answer 1: An abdominal ultrasound is recommended for men between ages of 65 and 75 who have ever smoked, but this recommendation does not hold for women. Answer 3: The patient does not require a pap smear because she is older than 65 and does not have a history of cervical or endometrial malignancy, and all of her previous pap smears have been negative. Answer 4: The patient should next get her colonoscopy at age 72 since her last colonoscopy was at age 62 and was normal. Answer 5: The patient does not have any acute respiratory or pulmonary problems and therefore does not need a chest radiograph.
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