Can a chest X-ray miss the diagnosis of lung cancer?

Question

Hello doctor,

My husband is 50 years old and has been having a persistent cough for about five months now, along with occasional chest discomfort on his left side. His GP did a chest X-ray last month and said everything looked normal, and sent him home with some cough syrup.

However, the cough has not gone away, and he is losing weight, almost 5 pounds in two months, without any change in diet. He also had a sputum test, which came back negative for TB. He smoked for about 18 years and only quit three years ago.

I am very concerned, and I keep reading about lung cancer online, which is making me more anxious. My question is: can a chest X-ray miss lung cancer in a 50-year-old? From what I have read, it seems like X-rays are not always reliable for detecting early tumors, especially in certain parts of the lungs.

Should we be pushing for a CT scan or a PET scan instead? His doctor seems to think it is just post-viral, but something does not feel right to me. Are we wrong to be this worried, or should we seek a second opinion?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern.

I can understand why this is worrying you, and you are not wrong to feel this way. A cough going on for this long, along with some weight loss, does need a closer look, especially with a past history of smoking. Even though many times it turns out to be something less serious, like lingering airway irritation after an infection, we should not ignore it when it is not settling.

Coming to your question, a chest X-ray can sometimes miss lung cancer. It is not a very sensitive test, and smaller lesions or those in certain areas of the lung may not be clearly seen. I have seen patients where the X-ray looked normal, but a CT (computed tomography) scan later showed something that needed attention.

In a situation like your husband’s, the next reasonable step would be a CT scan of the chest. It gives much more detail and helps us understand what is going on more clearly. A PET (positron emission tomography) scan is not usually the first test; we consider it later only if something suspicious is found.

You are absolutely justified in wanting further evaluation. If things are not improving and symptoms are continuing, it is sensible to either discuss this again with your doctor or take a second opinion, preferably from a pulmonologist, and go ahead with a CT scan.

Hope I have addressed all of your queries and concerns. Do follow up whenever needed.

Thank you.