Other lung cancer-related changes that can sometimes occur may include repeated bouts of pneumonia , changes in the shape of the ngertips , and swollen or enlarged lymph node ( glands ) in the upper chest and lower neck ( Harrison 2008 ).
Clinical presentation and clinical judgment will dictate the next steps in assessment , using the data retrieved from the history and the physical exam . This may include testing , referral to a specialist , or both .
Testing
To determine the most bene cial method ( s ) to test for lung cancer in an asymptomatic patient potentially exposed to increased radon levels , more studies are needed . Methods may include using either low-dose computerized tomography ( LDCT ), chest x-ray ( CXR ), sputum cytology , or a combination of these tests ( Smith 2009 ; USPSTF 2004 ). Still , whether these tests can help prevent deaths from lung cancer is currently unknown .
For more information about lung cancer diagnosis and treatment , visit the National Cancer Institute ’ s ( NCI ) Physician Data Query ( PDQ ) sites . http :// www . cancer . gov / cancertopics / pdq �
Community Wide Screening
Screening at the community level for lung cancer in asymptomatic persons involves both bene ts and risks .
Screening is best described as tests to assess the likelihood of a disease or condition in an apparently healthy person . The fundamental purpose of screening is to prevent the onset of disease through early diagnosis and treatment .
Currently no e ective , community-wide screening methods are available for medical prevention or early diagnosis and treatment of lung cancer — radon-induced or otherwise — in asymptomatic persons . Neither the American Cancer Society ( ACS ) nor any other medical / scienti c organization recommends for or against screening for the detection of early lung cancer in asymptomatic individuals ( AAFP 2010 ; CTFPHC 2003 ; Smith 2009 ; USPSTF 2004 ).
But consider : screening for lung cancer that involves taking a CXR adds to the person ’ s radiation dose and increases the risk of lung cancer .
The sensitivity of LDCT for detecting lung cancer is four times greater than the sensitivity of CXR . Compared with CXR , however , LDCT is associated with a greater number of false-positive results , more radiation exposure — up to 100 times the radiation dose of a CXR — and increased costs .
Because of the high rate of false-positives , lung cancer screening will subject many patients to invasive diagnostic procedures . Although the morbidity and mortality rates from these procedures in asymptomatic individuals are not available , mortality rates because of complications from surgical interventions in symptomatic patients reportedly range from 1.3 to 11.6 %; morbidity rates range from 8.8 to 44 %, with higher rates associated with larger resections ( USPSTF 2004 ).
Other potential screening hazards are potential anxiety and concern from false-positive results and misplaced reassurance from false-negative results . These hazards , however , have not been adequately studied .
” The bene t of screening for lung cancer has not been established in any group , including asymptomatic high-risk populations such as older smokers . The balance of harms and bene ts becomes increasingly unfavorable for persons at lower risk , such as nonsmokers ” ( USPSTF 2004 ).
Key Points
Because exposure to increased radon gas levels is considered a signi cant environmental cause of lung cancer deaths , clinical assessment to include history and physical exam is reasonable for patients potentially exposed to increased radon levels .