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Sloan-Kettering MD warns: don't believe the hype about lung cancer screening

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Catching up on some important reading.

Before this week ends and before the piece is forgotten, I wanted to draw attention to Dr. Peter Bach’s column in Slate, “CT Scam: Don’t believe the hype about lung-cancer screenings.” He hits on evidence, on harms, on costs, and on marketing that has already exploded all over the country after the National Lung Screening Trial results were announced. Excerpts (although I urge you to read the whole piece at the link above):

“Cancer screening is fundamentally inefficient: Hundreds, and sometimes thousands, of people must be screened to help just one or two. Each person who undergoes the test may suffer consequences from it, even though most will never get any counterbalancing benefit. This is why the recent study–called the National Lung Screening Trial–focused on a narrow, “high-risk” subgroup of the adult population who ranged from 55 to 74 years old and had smoked at least a pack a day for 30 years. If they had quit, it was within the past 15 years.

These are strict criteria, and they ensured that the patients had a meaningful chance of developing lung cancer during the course of the decade long study–and thus an opportunity to benefit from being screened. But people who are younger or have smoked less than the test subjects are at much lower risk for the disease (although no one is entirely safe from it).

If you have a lower risk of lung cancer, there’s less of a chance that screening will help you, as you can’t prevent something that wasn’t going to happen. But that doesn’t mean there’s less of a chance you’ll be harmed by the procedure. Taking a CT scan of the chest can uncover something that looks abnormal but ends up being nothing. Along the way there are more scans, biopsies and, sometimes, unnecessary surgeries. In the NCI study one in four people had these false positives. A prior study from the University of Pittsburgh pegged the rate at around two out of five, and in that study one in 100 subjects had parts of their lung removed for no good reason.

Some day CT screening will save lives–hopefully a lot of them. It will harm some people, too. We can stay ahead in this tradeoff if we are circumspect about whom we screen, and if we don’t believe every radio ad we hear.”

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Comments (8)

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mysisterdalesgarden

November 19, 2010 at 4:47 pm

If you ever smoked, were exposed to smoke or just want to take preventative measures talk to your doctor, get a spiral ct scan. Lung cancer is curable in its early stages.
We need to raise awareness and money for the disease that is taking so many lives. Most people don’t know that getting a spiral ct scan can detect lung cancer when it is curable. It was too late for my sister. I hope others reading this will investigate early detection.
Both my husband and I get yearly scans. There were two scans that detected small nodes. He was scheduled to get re-scanned to determine if there was any change. Fortunately both times they resolved themselves and were probably an infection or irritation. We would rather have that happen every day of the week instead of being blindsided by lung cancer when it is in stage four. My sister never had a symptom until she was diagnosed with stage four terminal lung cancer.
When my sister died of lung cancer I started a memorial garden. The garden has helped me deal with the loss in ways I couldn’t imagine. I’ve taken over 5000 pictures of the beautiful blooms inspired by my sister. Many people after viewing the garden are leaving comments and making dedications to loved ones. Please visit and share the garden magic. http://www.mysisterdalesgarden.

Michael Kirsch, M.D.

November 20, 2010 at 9:01 am

The CT scan story was totally hyped. Even its supporters acknowledge that 300 smokers must be screened to save one person. Of course, you have to factor in the high percentage of false postivie results that will force healthy folks into the medical fun house. And, one study shouldn’t change the course of medical practice. Future studies may very well contradict the recent study’s conclusions, as often occurs in medicine.

Gregory D. Pawelski

November 21, 2010 at 7:55 am

The efficacy of screening for any medical condition depends not only upon test accuracy, but upon the efficacy of proceeding with definitive diagnosis and therapy versus the efficacy of doing nothing at all. There is no doubt that screening may identify cancer at an earlier stage than in the absence of screening.
Biologically, it appears that many cancers diagnosed at an earlier stage with screening are so aggressive that even at the time of earliest possible detection, there are already micrometastases, meaning that earlier extirpation of the primary tumor does not influence outcomes in a meaningful way.
More commonly, tumors are so indolent that metastases would not have occurred, even had diagnosis been delayed by one, two, or several years (i.e. until the lesion became palpable and was diagnosed in the former, pre-screening manner).
I’m not being insensitive to the situation. I lost my brother-in-law (my wife’s brother) to the overscreening and overtreatment process. He developed myelodysplastic syndrome (MDS) because of it. Sometimes with overscreening and overtreatment, while a life may be saved, a life may be taken.

Travis Michael

November 22, 2010 at 12:26 pm

I agree that the news of CT scans might have thousands of people getting unnecessary tests that will expose them to radiation. In my personal opinion, only people who have a high risk of lung cancer such as long time smokers and people exposed to toxic materials such as radon gas and asbestos fibers should be checking into this.
TM http://www.mesorc.com/