Question of the Week # 125

Q125) A 55 Year old man comes to your office with complaints of progressively shortness of breath on exertion for the past 3 months. Physical examination reveals scattered wheezes . Pulmonary function tests reveal irreversible obstructive pattern. The patient is started on tiotropium inhaler. His other medications include enalapril for hypertension and over-the-counter vitamin supplements that he routinely uses on a daily basis which include Vitamin A, Vitamin B-complex, Beta-carotene , Selenium and Vitamin E. Chest X-ray is consistent with chronic obstructive airway disease but did not reveal any lung nodules or masses. The patient is counselled about lung cancer risk and strongly counselled on cessation of smoking. In addition to counselling regarding smoking cessation, which of the following is the most important measure to reduce his lung cancer risk?

A) CT scan of the chest every year

B) Discontinue Vitamin E

C) Discontinue Selenium

D) Discontinue Beta Carotene

E) Start Vitamin D supplements for chemoprevention



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8 Responses

  1. E

  2. a- ct scan chest every year

  3. D

  4. A, mostly because beta-caroten increase the risk for lung cancer and the other answer has not proven to reduce lung cancer. So CT only one here could be helpful eventhough there is no yearly image screening for lung cancer dx.

  5. Answer : D.

    Beta carotene has been shown to increase the risk of lung cancer among smokers. People who took dietary supplements of the nutrient beta-carotene while enrolled in a large cancer prevention trial continued to have increased rates of lung cancer even six years after the trial was stopped early and the supplements discontinued. Contrary to earlier expectations, not only do beta-carotene supplements not prevent lung cancer in people at high risk for the lung cancer, they appear to increase rates of the lung cancer, particularly among smokers.

    A is incorrect. Screening will not reduce the lung cancer risk. Annual screening with CT Scan of the chest has not yet been shown to reduce the mortality of the lung cancer. NIH is currently is conducting a large study that should conclusively answer if either spiral CT or chest X-ray can reduce lung cancer deaths.

    B is incorrect. There is no conclusive association between Vitamin E and Lung Cancer. Smokers given vitamin E supplementation during a six-year clinical trial showed no reduction in their lung cancer risk.

    C is incorrect. Selenium has not been shown to increase the lung cancer risk nor has it been proved to protect against lung cancer.

    E is incorrect. Though Vitamin D has been shown to prolong survival in lung cancer patients in some small trials, there is no evidence that it prevents lung cancer.

  6. smoking plus d/c beta carotene

  7. Thanks for taking the time to discuss this, I feel strongly about it and love learning extra on this topic. If possible, as you achieve experience, would you mind updating your blog with additional info? It is extremely useful for me. #niotrans

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