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Who should get screened for lung cancer?

Rating

5 Star

Who should get screened for lung cancer?

Our Review Summary

In the same week that new data were published by the US National Lung Screening Trial – subject of some badly flawed national news coverage – here’s a story on a different lung screening trial in Japan.

To those journalists who are challenged by screening stories – as many are – there are many lessons from the way this story was reported:

  • how to deliver caveats and limitations up high in the story and throughout
  • how to emphasize what WAS shown and what WASN’T and how this might not be generalizable
  • cost implications
  • harms of screening.

And all in fewer than 800 words. It doesn’t require a PhD candidate writing a dissertation to evaluate evidence in a news story.

 

Why This Matters

Costs, harms and limitations of the evidence – issues often left out of many screening stories – were emphasized in this one.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story emphasizes cost several times, including the estimate of a few hundred dollars per scan.

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

Satisfactory

The story explained: “Five years after their diagnosis, 95 percent of people whose cancers were found through a CT scan were still alive, compared to 73 percent diagnosed with an X-ray and 40 percent of patients who had not been screened and whose symptoms led to discovery their disease.”

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

Satisfactory

No quantification of what may have been observed in the study, but adequate general caveats were given:

“… each scan exposes a person to radiation, which also slightly increases cancer risks over time with repeated scans.

And screening comes with an inherent risk of false-positives — scans which suggest a lung cancer that turns out not to be there.

Dr. Christine Berg, one of the leaders of the U.S. screening studies, said that generally about a quarter of chest CT scans show some kind of abnormality — but 96 percent of those abnormal scans turn out not to be lung cancer. While doctors ruled out cancer, those patients would have undergone further tests, sometimes including biopsies, which can cause complications including infection and bleeding.

And for some patients, “if you really weren’t going to benefit from the screening…that complication is something you may not have faced,” Berg said. “Those are some of the things I worry about.”

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

Satisfactory

Limited generalizability of the findings is stressed as early as the second sentence, and the story concludes with “it’s not a home run and it clearly has these limitations.”

It also gave important context: “The U.S. Preventive Services Task Force, a federally-supported expert panel, has said there isn’t enough evidence for it to recommend screening for lung cancer in symptom-free people using CT scans or other methods.”

Does the story commit disease-mongering?

Satisfactory

No disease mongering of lung cancer.

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

Satisfactory

Good perspective added from one of the leaders of US lung screening studies.

Does the story compare the new approach with existing alternatives?

Satisfactory

The focus of the story was a comparison of lung CT versus x-rays or physician followup of patient symptoms.

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

Satisfactory

The story differentiates between this study’s screening in people who’ve never smoked and the practice in non-Asian countries where most lung cancers are found in people who’ve smoked. It stated:

“East Asian countries are more likely to regularly screen non-smokers for lung cancer because biological differences seem to put Asians at a higher risk than other non-smokers, researchers explained.

Non-smokers without symptoms generally are not screened for lung cancer in the U.S.”

Does the story establish the true novelty of the approach?

Satisfactory

The story put the new study in the context of other research in this field.

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

Satisfactory

It’s clear the story didn’t simply rely on a news release.

Total Score: 10 of 10 Satisfactory

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