Lung Cancer Lesions Often Missed On Chest X-Rays

For a number of reasons, failure to detect lung cancer on chest x-rays is not unusual and leads to delays in treatment or palliation of symptoms.

An ensuing delay in diagnosis and start of treatment may contribute to Britain having one of the lowest survival rates in Europe for the disease, declares Dr Michael Greenstone from the Medical Chest Unit, Castle Hill Hospital, Cottingham, England. This view follows a study of all patients, over a 12-month period, who had a histologically proved diagnosis of lung cancer.

Lung cancer is the most common cause of cancer related death in Britain where five-year survival rates are lower than in most European countries, the clinicians note. There are several reasons for this, but one may be the frequent presentation of patients with late-stage disease and the presence of comorbidities that preclude surgery.

There are a number of ongoing studies investigating the possibility of screening for lung cancer but, at present, most patients are symptomatic at diagnosis and initial investigation is chest radiography. After finding several cases of lung cancer in patients where a retrospective review of x-rays revealed an unrecognized abnormality, Dr Greenstone and colleagues undertook this present study.

The researchers examined the x-ray films going back five years and the case notes of a sample of 100 patients diagnosed with lung cancer in 1997 at one chest unit . Twenty two patients had to be excluded because it was impossible to trace previous x-ray films.

Average age of the cohort was 70 and approximately two-thirds were men. For almost three quarters of the patients, an x-ray had been requested because of chest symptoms, such as cough or breathlessness.

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