Heinrich Carl T, Stabbert Stephen, Sanchez Dayan, Lim Jayton A, Martin David E, Sukpraprut-Braaten Suporn
Graduate Medical Education, Unity Health, Searcy, USA.
Internal Medicine, Unity Health, Searcy, USA.
Cureus. 2023 Apr 27;15(4):e38213. doi: 10.7759/cureus.38213. eCollection 2023 Apr.
Lung cancer is the leading cause of cancer deaths in the United States. Efforts to decrease the number of deaths over the last decade have included the publication of guidelines by the United States Preventive Services Task Force (USPSTF) recommending annual low-dose computed tomography (LDCT) scanning in patients meeting specific criteria in order to facilitate the detection and classification of potential cancers, allowing for earlier and possibly curative intervention. Unfortunately, not every patient who meets these criteria will receive LDCT surveillance due to low socioeconomic status, geographic barriers, and limited access to healthcare related to the growing shortage of primary care physicians. We describe a case in which a patient located in a rural southeastern region of the United States presented to the emergency room with a one-week history of fevers, cough, and shortness of breath. Chest imaging revealed findings consistent with community-acquired pneumonia (CAP). He had over a 30-pack-year history of smoking cigarettes and fit the additional criteria within the USPSTF recommendations for annual LDCT scans for lung cancer screening though no screening records were found. While being treated for CAP as an inpatient, the decision was made to perform additional imaging of the patient's left hip, as he had been having increasing pain during the hospital stay. A mass lesion was seen on computed tomography (CT) scan in the posterior acetabular roof, prompting additional imaging and biopsy, which led to findings consistent with stage IV metastatic pulmonary adenocarcinoma. While improvements in both imaging and classification of potentially malignant pulmonary nodules and masses have been observed since the USPSTF recommendations were first released in 2013 and with the 2021 update, rural populations with high-risk patients who fit the criteria for LDCT scanning remain vulnerable to non-screening. This patient may have benefitted from annual LDCT screening for lung cancer. Encouraging primary care physicians to not only screen for current tobacco use but also to have necessary resources on hand in clinics to arrange for timely and appropriate screening appointments and follow-up visits is integral to improving the detection and early management of lung cancer. System-wide implementation of actions that may be carried out on multiple levels of care might provide both practitioners and patients with additional tools needed in a rural setting to decrease the number of lung cancer deaths.
肺癌是美国癌症死亡的主要原因。在过去十年中，为减少死亡人数所做的努力包括美国预防服务工作组（USPSTF）发布指南，建议符合特定标准的患者每年进行低剂量计算机断层扫描（LDCT），以便于检测和分类潜在癌症，从而实现更早且可能治愈性的干预。不幸的是，由于社会经济地位低、地理障碍以及与初级保健医生日益短缺相关的医疗保健可及性有限，并非每个符合这些标准的患者都会接受LDCT监测。我们描述了一个病例，一名位于美国东南部农村地区的患者因发热、咳嗽和呼吸急促一周的病史前往急诊室。胸部影像学检查结果符合社区获得性肺炎（CAP）。他有超过30年的吸烟史，符合USPSTF关于肺癌筛查年度LDCT扫描的其他标准，尽管未发现筛查记录。在作为住院患者接受CAP治疗期间，决定对患者的左髋部进行额外的影像学检查，因为他在住院期间疼痛加剧。计算机断层扫描（CT）显示髋臼后顶有一个肿块病变，促使进行额外的影像学检查和活检，结果与IV期转移性肺腺癌一致。自USPSTF于2013年首次发布建议以及2021年更新以来，虽然在潜在恶性肺结节和肿块的影像学检查和分类方面都有所改进，但符合LDCT扫描标准的高危农村人群仍然容易无法接受筛查。该患者可能会从肺癌年度LDCT筛查中受益。鼓励初级保健医生不仅要筛查当前的烟草使用情况，还要在诊所备有必要的资源，以便安排及时且合适的筛查预约和随访，这对于改善肺癌的检测和早期管理至关重要。在多个护理层面上可能实施的全系统行动，可能会为农村地区的从业者和患者提供减少肺癌死亡人数所需的额外工具。
