The Downside of a Cancer Study Extolling CT Scans

Does the story adequately discuss the costs of the intervention?

Satisfactory

Good job on this.  The story stated:

• “For now, most consumers who want a scan will have to pay for it themselves, although it is expected that insurance companies eventually will approve scanning for those in high-risk groups. (Medicare officials have indicated that they will soon reconsider paying for the screening tests.) The government has estimated the cost at about $300 a scan, but some centers may charge $1,000 or more.”

 However, it could have also included at least a line about the costs of following testing and possible treatment of false positives.

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

Satisfactory

Excellent.  The story put the important number needed to screen in the third sentence of the story:  “A major government study found the screening scans saved the life of one person for every 300 current or former smokers who were scanned.”  It went on to explain “The study was stopped when it was found that the scanning group had a 20 percent lower risk of dying from lung cancer than those being screened with X-rays.”

It could have done so in absolute terms, not relative risk reduction, but overall it warrants a satisfactory score.

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

Satisfactory

The story was clear on this:

• “But the early results also showed a downside of scanning: one of every four lung scans showed an abnormality, which often led to additional worry, radiation exposure from follow-up scans and, sometimes, lung biopsies and even risky surgery. But because the study was stopped early, a full analysis of the harms caused by screening scans is still months away.”

In a rarity for such a story, “downsides” was even in the headline.  The third paragraph read:  “But now cancer and screening experts are worried that the limited findings will be used by private screening centers to promote the test to a broader group than was studied. That, in turn, could lead to thousands of unnecessary lung scans, causing excess radiation exposure and unnecessary biopsies and surgery.”

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

Satisfactory

In clear language, the article explained key points about the study, including its limitations:

• It was very clear on the study population: “The study, called the National Lung Screening Trial, focused on a specific high-risk group: 53,000 current and former heavy smokers, aged 55 to 74, who had smoked for at least 30 pack-years. That means someone who smoked one pack a day for 30 years, two packs a day for 15 years or three packs a day for at least 10 years would qualify for the study. Former smokers who had accumulated 30 pack-years were included only if they had stopped smoking within the previous 15 years.”
• The study was stopped when it was found that the scanning group had a 20 percent lower risk of dying from lung cancer than those being screened with X-rays.
• But because the study was stopped early, a full analysis of the harms caused by screening scans is still months away.

• While the study found a benefit to scanning a specific group of high-risk smokers, that doesn’t mean other groups will get the same benefit.

Does the story commit disease-mongering?

Satisfactory

Good job here as well.  The quote from Dr. Otis Brawley of the American Cancer Society was key:  “To take a trial that involves people at high risk for lung cancer and to extrapolate it and say it’s good for people with intermediate or low risk is not appropriate.”

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

Satisfactory

Good sourcing – including quotes from one who promotes the scans and the study findings and from two who have concerns and are skeptical or worried about the impact.

Does the story compare the new approach with existing alternatives?

Satisfactory

The one comparison was the synopsis of the key study finding: “The smokers and former smokers were given either annual CT lung scans or chest X-rays. Compared with conventional X-rays, the CT, or computed tomography, scans create a detailed three-dimensional image of the lungs. The study was stopped when it was found that the scanning group had a 20 percent lower risk of dying from lung cancer than those being screened with X-rays.”

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

Satisfactory

The availability of CT scanners to do lung cancer screening was clear from the story.  More importantly, though, was the question of interpreting those scans – with questions raised in this excerpt about the problems even experienced radiologists at major cancer centers had:

• “Reading the scans is tricky because harmless nodules can be misinterpreted as suspect lesions. In the study, even experienced radiologists at major cancer centers had a high rate of false positives, suggesting that the rate would be even higher in the real world.”

Does the story establish the true novelty of the approach?

Satisfactory

The story explained that some were already promoting the study’s findings in news releases saying that the study “should once and for all settle the controversy” about whether CT lung scans save lives.  But it quickly countered that claim with observations from Dr. Otis Brawley of the American Cancer Society who said that he was worried that the few early press releases and radio advertisements are just the beginning of widespread promotion of screening lung scans.

“It was sort of ominous to be working Sunday evening in my home office and this thing comes on the radio,” he said. “A lot of people run out when there is a new announcement and get the new test. We’re very frightened some people are going to be harmed because of this.”

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

Satisfactory

This column did not rely on a news release.