Oncology (General Cancer)/Lung nodule


I have a question about 2 CT scans that I had in 2011 and 2012.  My Mother died of small cell lung cancer at 73 and my sister died of large cell lung cancer at 68.  They both were lifelong smokers.  I also smoked off and on for about 20 years.  I haven't smoked in 18 years.  I was raised with smokers so I was exposed to cigarette smoke for most of my life.  I brought this up to my Doctor and he sent me for a CT scan in 2011.  It showed that I had a 3mm noncalcified nodule in the left long base and a large right lung base peripheral granuloma/versus calcified pleural plaques. It said to have another CT scan in a year.  I did have one in 2012 and it showed no change.  My Doctor didn't recommend any follow up but of course I am concerned.  I am 63 and in good health otherwise.  I would appreciate your opinion.  Thank you, Liz

Here is what we know.  First, if two years go by and ambiguous abnormalities in the lungs remain the same, the general consensus is that further scanning is unhelpful -- It's just like scanning the population at random, or even a population of healthy cigarette smokers.  Although you may turn up an ocassional cancer, chances of curing that are only about one in 10 (based on randomly detected cancers).  So most authorities don't recommend CT scans as useful screening tools.  That being said, there is evidence that people who have been smokers should probably have one CT sometime in their 50's or so.  The kind of CT recommended is a "spiral" CT as opposed to an ordinary one.  If no abnormalities are noted, the person is at very low risk for lung cancer.  
There is not consensus, however, in this recommendation.
The second point is that people who have non-cancerous abnormalities in chest x-rays or scans have an increased risk of developing lung cancer -- but the abnormalities don't turn into cancer, they are just markers.  The risk is in the lung with the scar.  Granulomas are probably not the same thing as scars, though.  Most radiologists would not worry about calcified lesions.  
Finally, the worst case scenario in your situation is that if you do have scarring as a cause of the granuloma, your risk (being a current non-smoker) of getting lung cancer each year for 12 years is about 1.5 times the risk of a non smoker.  
Exercise, especially sustained exercise (treadmill, bicycling, running, swimming) seems to be the best thing anyone can do to lower the risk.  I hope this helps put your mind at ease.  That you've gone from 2012 to now without developing cancer means that what was seen in those two CT scans is not cancer.  

Oncology (General Cancer)

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Donald Higby, M.D.


I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.


I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

American Society of Clinical Oncology

New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

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