May 22, 2023Liked by William H Bestermann Jr MD

I appreciate your Substack, Doc. So I am thinking about the people who have died from lung cancer, yet never smoked. Christopher Reeve’s wife, Dana, comes to mind… And the former governor of Virginia, John Dalton. I’m sure there are many many other examples, these are just ones that came to mind right away. What about those folks??? Shouldn’t everybody be screened? Should you only be screened if you exhibit certain symptoms? If so, what are the symptoms? After a certain age, say 40, wouldn’t a scan be a good idea, giving you cardiac calcium info and whatever is going on in your lungs.

I had a cardiac calcium scan a couple years ago, it never occurred to me to. think about if they could see anything with my lungs… hopefully the doctor reading the scan would include observations about the lungs if he saw anything...

I remember the tech let me look at the scan after it was done, and I was very concerned about some white areas I saw… She said, “those are your ribs .” 😅

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It is always great to hear from you and these are good questions. The best medical decisions are based on risk, benefit, and cost. Smokers have the highest risk, but other things like excess abdominal fat and environmental toxins also play a role. As it is, only a very tiny fraction of these high risk patients are being screened. "The 2022 “State of Lung Cancer” report shows that only 5.8% of eligible Americans have been screened for lung cancer, and some states have screening rates as low as 1%." The idea is to screen before there are symptoms when the tumor is small and you can be cured.

You are correct about the coronary calciium score. There are small masses that are frequently seen and most of them turn out to be scars from old infections, benigh tumors etc. These are taken seriously.


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