CT Lung Cancer Screening Recommended For Heavy Smokers With Pneumonia

Low-dose computed tomography for lung cancer may be warranted in heavy smokers hospitalised with community-acquired pneumonia

medwireNews: Heavy smokers who are hospitalised with community-acquired pneumonia (CAP) have a high rate of lung cancer diagnosis in the following year, suggests research published in The American Journal of Medicine.

The study followed-up 363 patients with 381 hospital admissions for CAP between 2007 and 2011, all of whom had a smoking history of at least 30 pack–years. In all, 31 patients were diagnosed with lung cancer in the 12 months after admission, giving a cumulative incidence of 8.14%.

“To the best of our knowledge this is the highest reported rate of new lung cancer in the year following pneumonia”, say Daniel Shepshelovich, from Beilinson Hospital in Petach Tikva, Israel, and co-authors.

And this incidence rose to 23.8% for the 47 patients who had upper lobe pneumonia compared with just 5.5% for the 221 patients with lower lobe pneumonia.

“We believe this finding might be explained by the fact that upper lobe pneumonia is significantly less common than lower lobe pneumonia”, the researchers observe.

“Thus, an equal number of new malignancies in upper and lower lobes will make upper lobe pneumonia much more likely to represent an occult cancer than lower lobe pneumonia.”

Indeed, the authors report that 75.8% of lung cancers detected were in the lobe affected by pneumonia, “probably representing either post obstructive pneumonia or the lung cancer itself initially diagnosed as pneumonia”.

Daniel Shepshelovich et al note that the majority of patients in the study would have been eligible for lung cancer screening with low-dose computed tomography, as per the National Lung Cancer Screening trial criteria.

“[A]s most of the lung malignancies were probably present during the initial hospitalization, either as the direct cause of a post obstructive pneumonia, as the true etiology of the chest X-ray abnormalities initially diagnosed as pneumonia or as a risk factor for severe pneumonia, we believe a low dose chest computed tomography should be acquired during the hospitalization, to facilitate an early diagnosis”, they recommend.

Follow-up imaging 4 to 8 weeks after pneumonia has resolved may also be appropriate, they add.

Nevertheless, the authors admit: “A large prospective trial is needed to investigatewhether early diagnosis of lung cancer in this patient population will translate toprolonged survival and lower rates of deaths attributed to lung cancer.”

Reference

Shepshelovich D, Goldvaser H, Edel Y, et al.High lung cancer incidence in heavy smokers following hospitalization due to pneumonia. Am J Med 2015; Advance online publication 6 November.doi: 10.1016/j.amjmed.2015.10.030.

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