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Lung Nodules

Incidental and Screening.

Points about Looking for Lung Nodules

  1. Relatively new phenomenon based on Technological innovation.
  2. Developed scientific jargon with MIA and lepidic etc and a 'theory' of lung cancer development. However this is largely a function of what we find on CT thus an instrumentalist bias.
  3. Multiple guidelines reinforce the sense of mastery and control and thus exaggerate the efficacy of intervention here and this feeds into the popular perception of Medical ability and patients' expectation.
  4. But, there were/are no high quality outcome studies on incidental findings and that even in the screened population and highly controlled studies with highly selected patients with optimised risk-benefit ratios and the usual trial bias, there is no improvement in mortality, despite some studies getting 20-25% reduction in lung cancer mortality and lung cancer deaths being very common.
  5. But, there are real costs to this (in)action. There are real psychological effects from screening and real effects on the individual from being told

Lung Cancer Mortality

In men declining by 25% every 13y in UK 1

In women declining slower so overall is nearly the same:

  1. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/mortality#heading-Two ↩