Kaiser Suggests Dialing Back On Chest Scans

Kaiser Permanente is tentatively suggesting patients who undergo computerized chest tomographies be warned by their physicians that identifying nodules in the lungs is often a common result, and that doctors themselves should reconsider their use of the procedure.

The recommendation was made by a key Kaiser physician and researcher after data from its Southern California division concluded that the number of patients who have been identified to have had lung nodules skyrocketed in recent years.

According to Kaiser's data, its Southern California patients diagnosed with such nodules nearly doubled between 2006 to 2012, from 8,973 to 17,368.

“If we extrapolate our findings in Southern California to the U.S. population, more than 1.5 million Americans could expect to have a nodule identified each year,” said Michael Gould, M.D., a Kaiser senior research scientist and the healthcare system's director for Health Services Research and Implementation Science. 

The Kaiser study concluded that was primarily because more patients have undergone chest computed tomography scans – the proportion grew 55% between 2006 ad 2012, to nearly 54,000. Yet despite the far greater incidence of identifying lung nodules in patients, the rate of those patients diagnosed with lung cancer within two years did not increase at all. 

Altogether, about 2% of patients who have nodules wind up being diagnosed with the disease, even though up to about a third of all patients who are scanned have nodules detected. And 44% of those diagnosed with nodules never smoked, which is considered one of the primary risk factors for developing lung cancer. However, many patients who have nodules are often subjected to further CT scans to check for growth, and occasionally lung biopsies.

“The research needs to catch up to the clinical practice,” Gould said. “This doesn’t mean the increased use of chest CT is not warranted, since the scans are often performed for reasons other than lung cancer screening, but it does suggest that increased vigilance for detecting incidental lung nodules may not be beneficial.”