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Special CT scans cut lung cancer deaths in major study, but questions remain about screening

Rating

4 Star

Special CT scans cut lung cancer deaths in major study, but questions remain about screening

Our Review Summary

It’s clear that this story worked very hard to avoid hyping the results of the National Lung Screening Trial, which found that heavy smokers who were offered certain CT scans were less likely to die of lung cancer than those who were offered chest x-rays. It quickly puts the relative difference in death rates (20 percent) into context with the actual numbers (354 vs. 442 deaths among 53,500 participants). Near the top, this story tells readers of doubts about the balance of harms and benefits of this type of screening. It emphasizes that quitting smoking is the best way to avoid lung cancer death. However, it appears that the story is mostly based on material handed out by the National Cancer Institute, which sponsored the trial. It fails to give readers any independent perspectives on the trial or the meaning of its results. Even a call to the American Cancer Society would have provided a cautious viewpoint. (Please note: later versions of AP stories carried independent perspectives but we reviewed the first version we found.)

 

Why This Matters

News reports on medical trials must give readers a balanced perspective. But journalists should seek out independent sources, so that they are not dependent on the sponsor or lead researcher to provide that balance.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story reports that these scans typically cost $300-400 and are not generally covered by insurance. The story would have been better if it had clearly pointed out that the potentially huge cost of such a screening program, because hundreds of smokers had to be scanned to extend one life in this trial and follow-up tests and treatments cost much more than the initial scan. Nonetheless, we’ll give it the benefit of the doubt on this criterion. The New York Times never specified the scans’ costs.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

This story does a better job than some others in how it portrays the potential benefits of CT screening for lung cancer. The headline and lead report that deaths were reduced somewhat. The third paragraph of the story notes that among the 53,000 participants there were 20 percent fewer deaths among those offered CT scans compared to those offered chest x-rays, but that the “actual number of deaths averted was fairly modest” (354 in the CT group vs. 442 in the x-ray group). This way of presenting the results helps readers put the results in perspective. The story also notes that the National Cancer Institute said “it’s not clear that all smokers should get the scans.” However, the story could have made it more clear that the reduction in lung cancer death rates was seen after five years of folllow-up, which leaves open the question about whether that difference will persist over a longer time frame.

It would have been helpful for this story to tell readers that 300 smokers had to be screened in this trial in order to extend the life of one of them.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story points out that such scans can produce false positive results, lead to further tests and treatments that don’t always benefit patients and have their own risks, and that CT scans expose people to radiation that may raise the risk of other types of cancer.  It explains that the NCI is “still compiling the rates of false alarms and other risks” but estimates could have been drawn from past research.

Does the story seem to grasp the quality of the evidence?

Satisfactory

The story explains that 53,000 current or former smokers were given either CT scans or chest x-rays and that researchers tracked the number who died of lung cancer. However, readers may be confused by a reference to “the eight-year study period.” While it has been eight years since the trial began, the participants were followed for up to five years. Also, the story leads with a vague statement that this trial provides “the first evidence that a screening test may help fight the nation’s top cancer killer.” It would have been better for the story to be clear that this trial provides evidence about a difference in lung cancer death rates. The story could have done a better job of explaining that the randomization and other features of this trial set it above any other investigation of this topic.

Does the story commit disease-mongering?

Satisfactory

The story clearly states that this trial only involved people who are or were “very heavy smokers” and that it is not clear that the results are applicable to other smokers.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

There is no independent source quoted.  (Please note: later versions of AP stories carried independent perspectives but we reviewed the first version we found.)

Does the story compare the new approach with existing alternatives?

Satisfactory

This story highlights advice that quitting is the best way for smokers to avoid lung cancer.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

While this story does call the CT scans used in this trial “special” and different from conventional CT scans, it does not make clear that the trial applied rigorous standards to the equipment, operators and radiologists that may not be followed by other providers who offer CT scans to smokers.

Does the story establish the true novelty of the approach?

Satisfactory

The story squeaks by this criterion. It mentions earlier trials that left key questions unresolved, but it does not clearly tell readers what was different about this trial.

Does the story appear to rely solely or largely on a news release?

Not Applicable

The only direct quote in the story is from a news release issued by the National Cancer Institute.
(http://www.cancer.gov/newscenter/pressreleases/NLSTresultsRelease)
It is not clear what other sources may have been consulted.

Total Score: 7 of 9 Satisfactory

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