Health News Review

It is still a difficult concept for many people to grasp:  how can there be harms from screening for cancer?

Maybe the study published this week in JAMA Internal Medicine, “Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer,” will make some of the potential harms a little more clear.

The analysis shows that nearly 20% of all lung cancers found by CT screening seemed to be harmless (indolent is the term the researchers used). The researchers wrote:

“These patients may undergo an invasive diagnostic procedure, have surgical resection, be given a diagnosis of lung cancer, and require multiple sequential follow-up studies when some tumors are potentially clinically insignificant. These cases of overdiagnosis are treated as any other lung cancer because it is generally not possible to distinguish indolent lesions from more aggressive tumors.”

AP reports:

“Putting the word ‘harmless’ next to cancer is such a foreign concept to people,” said Dr. Michael LeFevre, co-chairman of the U.S. Preventive Services Task Force.

In testimonials, patients often say lung cancer screening via CT scans cured them, but the study suggests that in many cases, “we cured them of a disease we didn’t need to find in the first place,” LeFevre said.”

WebMD quoted Dr. Otis Brawley of the American Cancer Society:

Brawley said the clinical trial had successfully detected two types of lung cancers — the 80 percent that could not be cured and the 20 percent that could be successfully treated.

“Now we’re realizing there’s a third kind of cancer — the kind that doesn’t need to be cured but can be cured,” Brawley said. “We cure some people who don’t need to be cured, but the study clearly shows by treating everyone we cure people who need to be cured.”

Meantime, the Chicago Tribune carried a story promoting a hospital’s free lung cancer screening on the same day that most other news media were reporting on the troubling findings from the study. The Tribune story made no mention of the new study.  Sigh.


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SANDY MACDONALD posted on December 16, 2013 at 1:06 pm

I would be very interested in an article that would review the data that indicates that some prostate, some breast, and, now, some lung cancers don’t need to be found and treated.
I don’t mean how to distinguish between the need-to-be-treated and the “indolent” ones when deciding whether to treat or not, but, rather, how do we know that a cancer removed would have never caused trouble or that a lesion, not removed, was a cancer that never caused trouble.

    Gary Schwitzer posted on December 16, 2013 at 1:51 pm

    That’s beyond the scope of what I can provide for you. (If you’ve followed this site regularly and recently, you know that I have lost my funding, and therefore, lost the services of the terrific team of people who once contributed to this site. So I’m flying solo for now.) However, the literature is deep on such questions.

    You could start by reviewing the lung cancer analysis linked to above. A breast cancer researcher and a prostate cancer researcher collaborated on an article, “Solving the Overdiagnosis Dilemma,” in the Journal of the National Cancer Institute.

    Sorry that I don’t have the wherewithal to do literature searches for readers of this site.