Beyond lung cancer: a strategic approach to interpreting screening computed tomography scans on the basis of mortality data from the National Lung Screening Trial.

Low-dose computed tomography screening in older patients with a heavy-smoking history can be viewed as an opportunity to screen for smoking-related illnesses and not just for lung cancer. Within the National Lung Screening Trial, 24.1% of all deaths were attributed to lung cancer, but there were significant competing causes of mortality in this patient population. Cardiovascular illness caused 24.8% of deaths. Other neoplasms were listed as the cause of death in 22.3%, and respiratory illness was the cause of death in 10.4%. All of these illnesses might be attributed to smoking. Low-dose computed tomography of the thorax may provide information about these diseases, which could be used to guide therapeutic intervention and, hopefully, alter the courses of these diseases. Information about coronary artery calcification, chronic obstructive pulmonary disease, and potential extrapulmonary malignancy should be provided in the report of the screening examination. This must be balanced against the risk of the burden of false-positive findings and the costs, both psychological and financial, associated with additional investigative evaluations.