One of the most common reasons for a new office referral is the discovery of a nodule on a patient’s CT scan of the chest, usually done during a work-up for some other illness or complaint.  The amount of new nodules being discovered has skyrocketed in the years between 1959 and today. In 1959 the number of nodules found annually was estimated to be 150,000 (by the way, gas was $0.25 a gallon and the average American home was $12,000). 

Today, the US population has almost doubled but the number of new lung nodules has risen to 1.5 million annually (and gas is now $2.70 a gallon and the average American home is $300,000).  The reason for this increase in findings is found in the practice of CT scanning which, of course, was not available in 1959. The problem with the increased number of new nodules is what to do about them.  We do have some guidance and methods which help us monitor the nodules based on size and patient risks (such as smoking history). 

However, not everybody is following the rules.  It appears that patients are often subjected to biopsies and surgeries that may be unnecessary.  Sometimes these approaches to diagnosis are physician-inspired and sometimes they are patient-inspired.  I understand that if I developed a new lung nodule I would want the best approach, but often times we do not know if a nodule is new or old.  Get the facts before you have anything done.