Annual Chest Xrays--pros & cons

[starion]

Hi!  I have severe emphysema & severe chronic asthma which is under good control (not alpha-1) & have never smoked or been exposed tu lung irritants.  I will be 50 this year & was diagnosed in 2000 at National Jewish.  My internist regularly  orders chest x-rays of all his patients in connection with their (generally annual) physicals.  I was just wondering about the pros & cons of this practice as I have never had anything significant showing up on any xrays & would like to minimize my exposure to radiation.  Of course, he does order chest xrays when I have bad respiratory infections to check for pneumonia as well.  There have never been any nodules on any xrays or CTs and no changes in my films since 2000.  My last chest xrays & CTs were at National Jewish 8/2004.

Would appreciate your thoughts and comments on pros & cons of regular chest xrays with physicals, so I can discuss this with my internist.

[National Jewish]

The disease being screened for by routine annual physical exam chest x-rays is lung cancer.  Debate continues about whether early detection makes a difference even in smokers or former smokers, but on the basis of the current evidence, neither chest x-ray nor CT scanning is recommended for screening.  This non-recommendation would be even more appropriate for someone, like yourself, who has never smoked, although having COPD, from whatever the cause, does increase your risk of lung cancer slightly.

The citation below is for an article from the Mayo Clinic.  It may be of interest to you and your doctor.  Lung Cancer Screening, Overdiagnosis Bias, and Reevaluation of the Mayo Lung Project by Edward F. Patz, Jr. in Journal of the National Cancer Institute, 2006, Volume 98, Number 11, pages 724-725.  The last paragraph of the summary follows:

'To date, substantial resources have gone into screening for lung cancer.  Despite the use of these various imaging modalities, trial designs, and the inclusion of hundreds of thousands of individuals, none of these studies have shown a reduction in lung cancer mortality.  The ongoing National Lung Cancer Screening Trial has randomly assigned more than 50 000 participants to CT or control chest radiograph arms and continues to follow patients.  Preliminary results will be available in the next several years (20,21).  As the debate over lung cancer screening continues, it has become apparent that we must learn more about the biology of this disease and integrate this knowledge with early diagnostic strategies.  Although we all want to reduce mortality from lung cancer, the theoretical benefits of screening must be validated by appropriate, rigorous clinical trials before being introduced into routine practice'.

[starion]

Thanks very much for your thorough and thoughtful comments.  It will provide more for me to discuss at my next visit with my internist.  He did indicate that because NO ONE knows why I have severe emphysema, I'm at slightly higher risk for lung cancer (like Alphas).  I too have read of the studies which don't indicate any increased benefit from xray & CT screening for lung cancer.  So much to think about & discuss--thanks for providing more "food for thought."

Starion