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Lung scans may lead to overdiagnosis: study

Rating

4 Star

Lung scans may lead to overdiagnosis: study

Our Review Summary

We identified three shortcomings – all easily addressed.

  • Costs weren’t mentioned – a big factor in a story about overdiagnosis and overtreatment.
  • No independent expert was quoted.
  • Had there been an independent voice, perhaps some of our comments about evaluating the limitations of the evidence would have been addressed.

 

Why This Matters

Putting hard numbers to concerns about overdiagnosis and overtreatment is a vital health policy issue – and important for journalists to track, as Reuters did with this story.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No mention of cost – a signficant issue in the context of alleged overdiagnosis.

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

Satisfactory

The story succinctly summarized:

  • In the years before 1998, when the technique was introduced, 62 per 100,000 Americans were diagnosed with a pulmonary embolism annually. After 1998, that number rose to 112 per 100,000. The number of deaths caused by the condition dropped only little, however: from 12.3 per 100,000 in 1998 to 11.9 per 100,000 in 2006. “This is consistent with overdiagnosis of pulmonary embolisms that may have caused very little harm, may not have caused death,” said Dr. Renda Soylemez Wiener of Boston University, who worked on the study.

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

Satisfactory

The story explained: “the blood-thinning drugs used to treat blood clots increase the risk of bleeding in the brain or gastrointestinal tract, for example. According to the new results, such complications rose from three to five per 100,000 people hospitalized with PE per year after doctors began using chest CT scans.” It also reported: “CT scans expose patients to radiation, for example, which can increase the likelihood of developing cancer. And the dyes used to enhance the scan also cause kidney damage in a significant portion of people.”

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

Not Satisfactory

Our medical editor who reviewed this felt strongly that an unsatisfactory grade was warranted for the following reasons. There are important limitations to consider. The diagnosis of pulmonary embolism prior to CT was always fairly uncertain because pulmonary angiography (the true gold standard) was rarely done due to complications of the test. Therefore, the baseline trends for incidence of pulmonary emboli are probably not very reliable. There are also lots of other tests and approaches used for PE diagnosis that could have influenced things in either direction, as well as trends/improvements in treatment of PE. Relying on discharge diagnoses from inpatient samples should always be used with caution. A validation procedure with a subsample of cases could have added more strength in the reliability and validity of the diagnoses. Perhaps if an independent expert’s perspective had been included, some of this may have been addressed.

Does the story commit disease-mongering?

Satisfactory

No disease-mongering of pulmonary emboli.

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

Not Satisfactory

No independent source was quoted. It would have been interesting to solicit opinions from radiologists, for example, that might have placed some of this in a different light.

Does the story compare the new approach with existing alternatives?

Satisfactory

The dilemma was framed appropriately at the end:

  • “I think doctors should think carefully about the pretest probability of a pulmonary embolism before they order this test,” Wiener told Reuters Health. Yet there is no easy solution at this point, because untreated blood clots can be fatal, she added. “Right now, it is a difficult place for the patient to be in,” Wiener said.

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

Satisfactory

The story states that chest CT scans are “being used in millions of patients every year in the US.”

Does the story establish the true novelty of the approach?

Satisfactory

The relative novelty of the new analysis was clear from the story. It stated: “The new findings add to other evidence showing that medical testing is on the rise across the U.S., although in many cases the impact on overall health remains unclear.”

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

Satisfactory

It’s clear that the story did not rely solely on a news release.

Total Score: 7 of 10 Satisfactory

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