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TheNNT on lung cancer CT

I like the work of the website called TheNNT.com because its analysis of the number needed to treat (or to screen) could be a good resource for journalists as they struggle to tell these stories. Here is the graphic TheNNT.com just published from its analysis of the lung cancer CT screening data.

NNT on lung ct.jpg

The report of The National Lung Screening Trial (NLST) Research Team – with the conclusion that “Screening with the use of low-dose CT reduces mortality from lung cancer” has now been published in the New England Journal of Medicine.

It’s accompanied by an editorial by Dartmouth’s Dr. Hal Sox, that reads in part:

“Individual patients at high risk for lung cancer who seek low-dose CT screening and their primary care physicians should inform themselves fully, and current smokers should also receive redoubled assistance in their attempts to quit smoking. They should know the number of patients needed to screen to avoid one lung-cancer death, the limited amount of information that can be gained from one screening test, the potential for overdiagnosis and other harms, and the reduction in the risk of lung cancer after smoking cessation. The NLST investigators report newly proven benefits to balance against harms and costs, so that physicians and patients can now have much better information than before on which to base their discussions about lung-cancer screening.

The findings of the NLST regarding lung-cancer mortality signal the beginning of the end of one era of research on lung-cancer screening and the start of another. The focus will shift to informing the difficult patient-centered and policy decisions that are yet to come.”

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Comments

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Susan Fitzgerald

August 10, 2011 at 11:59 am

Wow, that’s staggering, especially considering it’s only in the high-risk group. People think screenings are harmless. They need to know differently. Thanks for sharing this.
BTW – had occasion to look up your team’s assessment of coverage on Vitamin D to refute some other blogger who’s still beating the drum on discredited claims about it. Thanks for your great work.

Micki Jacobs

August 11, 2011 at 9:05 am

this site IS interesting, however the data used for vitamin D as it relates to community fracture risk has included one of the most ridiculous studies EVER. Namely, the one where an entire year of vitamin D was administered at one time in elderly and then they decided that it was detrimental. How ridiculous! I mean, who in their right mind thinks that we could give an entire year’s worth of ANY nutrition at one time and think this is even logical?

DH Newman

August 11, 2011 at 12:12 pm

Glad you like the site.
Regarding the study you mention (I presume Smith et al, 2007 from Rheumatology) this was a three-year study of annual Vitamin D2 injections. They use the same dosing used by bisphosphonate preparations that work via the same mechanism, thus there isn’t any reason I know of to consider it a ridiculous proposition. Moreover the study was done to test promising results from an earlier non-randomized study of the same drug and dosing (Heikenheimo et al, 1992).
Perhaps more importantly this one study, despite being about 9000 subjects, did not drive the results. There was also no benefit in the other 16000 subjects reviewed. Thus it seems likely that the results are sound.

aek

August 15, 2011 at 7:35 am

The NNT database and analysis has grown exponentially.
I notice that one glaring omission is that of psychiatry and mental health diagnoses and treatments. That data would be incredibly interesting.