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DEAR DR. ROACH: When I was about 6 years old in the early '40s, my 16-year-old brother was sent to a sanitarium for tuberculosis patients. He was there for 18 months and was a survivor.

During this period of time, we (the family) went regularly for chest X-rays and some kind of test that involved a needle in my forearm. Why aren't X-rays done today -- not to detect tuberculosis but to look for cancer? CT scans are expensive and sometimes involve a long wait, so why not do a simple X-ray for starters? And then if they see something, perhaps they can do a CT scan? -- N.C.

ANSWER: Many physicians and scientists at Johns Hopkins, Memorial Sloan-Kettering, and other first-rate institutions have sought to answer the question of whether annual chest X-rays led to a reduction in the risk of dying from lung cancer. But unfortunately, the consensus of opinion is that chest X-rays do not lead to an improvement in lung cancer mortality. There were tens of thousands of participants in these studies.

You are also right to think that a CT scan might be more useful. Studies have shown that for a subset of people who are at a high risk, screening with a CT scan does lead to a reduction in lung cancer deaths. Specifically, lung cancer screening should be considered for people between the ages of 50-80 (Medicare will pay up to age 77) who are in generally good health; those who have smoked at least 20 "pack years" (such as a pack a day for 20 years, two packs a day for 10 years, or a half pack a day for 40 years); and those who currently smoke or have quit within the past 15 years.

The benefit from lung cancer screening is modest; it takes about 250 people to be screened annually for three years to prevent one lung cancer death. Still, this is significant, and I do discuss lung cancer screening with my eligible patients.

Finally, the best way by far to prevent lung cancer is to quit smoking as soon as possible. If you are a smoker, your doctor has many ways to help you quit. Calling a quit line, such as 800-QUIT-NOW, will connect you with your state service. You can also text QUITNOW to 333888, and there are web-based programs such as Smokefree.gov and apps like quitSTART from the National CANCER Institute.

DEAR DR. ROACH: My husband and I are over 65. We got the respiratory syncytial virus (RSV) vaccinations two years ago. I'm reading mixed reports on how often we should be getting them. -- N.W.

ANSWER: Along with influenza and COVID, RSV is yet another virus that causes respiratory disease in adults -- one that is especially dangerous for young children and older adults. It is recommended to be discussed for those who are over the age of 60.

People younger than 60 with moderate to severe immune system diseases, such as those that deal with an organ (especially lung) or a stem-cell transplant, should also consider vaccination. I recommend the vaccine to all adults over 75 and to those over 60 who have risk factors such as chronic heart or lung disease, complicated diabetes, or hemodialysis.

At the current time, booster doses of the RSV vaccine are not recommended. This may change; although there is evidence that immunity wanes after a year, repeat doses were not found to be helpful.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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