A 59-year-old man comes to the office for a routine wellness examination. The patient's medical history includes chronic bronchitis, hypertension, hypertriglyceridemia, and basal cell carcinoma. He smokes a pack of cigarettes per day, with a total 40-pack-year history. The patient typically consumes 1 or 2 cans of beer each night. Family medical history is remarkable for heart disease and diabetes mellitus. The patient had a normal screening colonoscopy 5 years ago. A chest x-ray from a year ago shows changes consistent with chronic bronchitis.
The patient asks if he is at increased risk for lung cancer because of his smoking history. What is the most appropriate response by the physician?

Question

A 59-year-old man comes to the office for a routine wellness examination.  The patient's medical history includes chronic bronchitis, hypertension, hypertriglyceridemia, and basal cell carcinoma.  He smokes a pack of cigarettes per day, with a total 40-pack-year history.  The patient typically consumes 1 or 2 cans of beer each night.  Family medical history is remarkable for heart disease and diabetes mellitus.  The patient had a normal screening colonoscopy 5 years ago.  A chest x-ray from a year ago shows changes consistent with chronic bronchitis. 
The patient asks if he is at increased risk for lung cancer because of his smoking history.  What is the most appropriate response by the physician?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c080_5929_8f63_312f8913b56a_MD0005_00 Long-term smokers are estimated to be at a 10- to 30-fold increased risk of developing lung cancer, with the cumulative cancer risk approaching 30% in heavy smokers versus 1% in nonsmokers. Screening chest x-ray has not been shown to be effective in diagnosing lung cancer or reducing morbidity or mortality rates. However, screening current and former smokers with annual low-dose helical CT scan reduces the number of lung cancer deaths. Current guidelines recommend screening beginning at age 50 for patients with a significant smoking history (ie, those with ≥20 pack-years who currently smoke or quit within the past 15 years) (Choice D). The risk for lung cancer declines with cessation of smoking, and screening can be discontinued once a patient has not smoked for 15 years. Screening generally should continue through age 80. However, it may be discontinued in patients who develop other conditions that significantly limit life expectancy or the ability to tolerate aggressive therapy, especially surgery, for lung cancer. (Choice A) Basal cell carcinoma is a common skin malignancy. It typically has an indolent course and is easily resectable. Basal cell carcinoma is linked primarily to sunlight exposure and does not appreciably increase the risk of lung cancer. (Choice B) Lung cancer and chronic bronchitis are associated with smoking, and the risk for lung cancer is significantly higher in patients with chronic bronchitis than it is in the general population. However, recommendations for lung cancer screening are based primarily on smoking history. Also, CT scan is the recommended screening modality, not chest x-ray. (Choice E) Sputum cytology has low sensitivity for lung cancer screening and is not recommended. Educational objective: Lung cancer screening by annual low-dose helical CT scan is recommended for patients age 50-80 who have a ≥20-pack-year smoking history and are current smokers or quit within the past 15 years. References: Screening for lung cancer: US Preventive Services Task Force recommendation statement. (http://www.ncbi.nlm.nih.gov/pubmed/33687470)

A 59-Year-Old Man Comes to the Office for a Routine