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Doctors May Miss Lung Cancer on X-Rays


NEW YORK (Reuters Health) - Missed diagnosis of lung cancer on a chest x-ray may be relatively common and can delay initiation of potentially life-saving treatment, according to the results of a study by British researchers.

"The most common reason for diagnosis of lung cancer being missed on a previous chest x-ray was a failure of the radiologist reporting the x-ray or the physician who requested the x-ray to recognize that it was abnormal," the investigators report in the March issue of the Postgraduate Medical Journal.

In the study, Dr. Michael Greenstone of Castle Hill Hospital in East Yorkshire, UK, and colleagues reviewed the medical histories and x-rays of 28 patients who were diagnosed with lung cancer.

Of the group, 14 of the lung cancer patients were found to have pre-existing chest x-ray abnormality. Most of the time, the patients had the earlier x-ray because they had cough, breathlessness, weight loss or other problem.

"A total of 19 errors were identified in these 14 patients," Greenstone and colleagues write. "One patient had an unrecognized abnormality on two occasions and two had an unrecognized abnormality on three occasions."

The investigation revealed that those with a delayed diagnosis lived between 55 and 219 days after their eventual diagnosis of lung cancer, whereas those who were diagnosed correctly lived between 137 and 512 days after diagnosis.

Those with a delayed diagnose on average went another 101 days before being correctly diagnosed with cancer, the report indicates.

The current 5-year survival rate for lung cancer is about 14%, but if cancer is detected earlier, the survival rate could rise to as high as 80%, according to experts. Early lung cancers are more likely to be operable.

Nonetheless, the authors point out that failure to identify lung cancer in chest x-rays is common. In general, tumors can be obscured in areas overlain with other body parts including the heart, rib cage, diaphragm or major arteries.

"Heightened awareness of the problems of diagnosing lung cancer is important for all doctors working in primary and secondary care," the researchers write.

"Efficient and rapid investigative pathways should be available for all patients with chest x-ray abnormalities suspicious of lung cancer," the team concludes.

SOURCE: Postgraduate Medical Journal 2002;78:158-160.


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