Few diseases are as misunderstood by plaintiff’s attorneys as lung cancer. The overall mortality of lung cancer is 90% and early detection by serial chest x-rays has not resulted in a better outcome. Only recent studies showing improved outcome with serial screening CT scans show promise in improving lung cancer mortality, but screening CT has not made it into the mainstream of medical practice. By the time the plaintiff complains of coughing up blood or chest pain it is almost always too late to affect a cure.
Solitary 2 cm pulmonary nodule in an asymptomatic individual: the only group in whom cure of lung is a probable outcome. Hilar and mediastinal nodes appear normal. At time of film, growth rate is unknown.
With a mortality of 90% there are few good plaintiff lung cancer cases. Several factors contribute to a winning proximate cause strategy for the plaintiff:
- No symptoms: by the time there is a symptom of lung cancer it is usually too late for a cure.
- No evidence of regional lymph node involvement on whatever imaging studies were done; even a single positive hilar lymph node reduces likelihood of survival to 25%.
- A discrete peripherally placed lung nodule less than 3 cm in diameter. Survival falls dramatically with larger lesions.
- A slow growth rate (doubling time of greater than five months).
What about failure to obtain a chest x-ray or CT scan in someone at risk (e.g. smoking history or symptoms)? Because of the variable natural history of lung cancer it is impossible to predict what that x-ray would have shown.
Is there a role for screening x-ray or CT in someone at high risk, e.g., smoking or asbestos exposure? Is there a winning strategy to sue a doctor over not screening? Good question. As of 2023, most august bodies such as the American Thoracic Society recommend screening in high-risk situations, but it is not clear whether this is tantamount to a new standard of care, since compliance remains low.