RESUMO
The American Thoracic Society Core Curriculum updates clinicians annually in adult and pediatric pulmonary disease, medical critical care, and sleep medicine at the annual international conference. The 2021 Pulmonary Core Curriculum focuses on lung cancer and include risks and prevention, screening, nodules, therapeutics and associated pulmonary toxicities, and malignant pleural effusions. Although tobacco smoking remains the primary risk factor for developing lung cancer, exposure to other environmental and occupational substances, including asbestos, radon, and burned biomass, contribute to the global burden of disease. Randomized studies have demonstrated that routine screening of high-risk smokers with low-dose chest computed tomography results in detection at an earlier stage and reduction in lung cancer mortality. On the basis of these trials and other lung cancer risk tools, screening recommendations have been developed. When evaluating lung nodules, clinical and radiographic features are used to estimate the probability of cancer. Management guidelines take into account the nodule size and cancer risk estimates to provide recommendations at evaluation. Newer lung cancer therapies, including immune checkpoint inhibitors and molecular therapies, cause pulmonary toxicity more frequently than conventional chemotherapy. Treatment-related toxicity should be suspected in patients receiving these medications who present with respiratory symptoms. Evaluation is aimed at excluding other etiologies, and treatment is based on the severity of symptoms. Malignant pleural effusions can be debilitating. The diagnosis is made by using simple pleural drainage and/or pleural biopsies. Management depends on the clinical scenario and the patient's preferences and includes the use of serial thoracentesis, a tunneled pleural catheter, or pleurodesis.
RESUMO
BACKGROUND: Lung cancer screening recommendations have been developed, but none are focused on veterans. We report the results of the lung cancer screening program at our Veterans Affairs medical center and compare them with historic results. METHODS: All veterans between 55 and 74 years who were current smokers or quit within the past 15 years and had at least a 30-pack-year smoking history were invited to receive an annual low-dose chest CT scan beginning in December 2013. Demographics, CT scan results, and pathologic data of screened patients were recorded retrospectively. Overall results during the screening period were compared with results in veterans who received diagnoses from January 2011 to December 2013 (prescreening period). RESULTS: From December 2013 through December 2014 (screening period), 1,832 patients obtained a screening CT scan. Their mean age was 65 years. A lung nodule was present in 439 of 1,832 patients (24%). Lung cancer was diagnosed in 55 of 1,832 screened patients (3.0%). During the prescreening period, 37% of every lung cancer detected at our center (30 of 82) was stage I or stage II. After implementation of the screening program that percentage rose to 60% (52 of 87; P < .01). During the screening period, 55 of the 87 diagnosed lung cancers (63%) were detected through the screening program. The number of lung cancers detected per month rose from 2.4 to 6.7 after implementation of the screening program (P < .01). CONCLUSIONS: Implementation of lung cancer screening in the veteran population leads to detection of an increased number and proportion of early-stage lung cancers. Lung cancer screening in veterans may also increase the rate of lung cancer diagnoses in the immediate postimplementation period.