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:
And all in fewer than 800 words. It doesn’t require a PhD candidate writing a dissertation to evaluate evidence in a news story.
Costs, harms and limitations of the evidence – issues often left out of many screening stories – were emphasized in this one.
The story emphasizes cost several times, including the estimate of a few hundred dollars per scan.
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.”
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.”
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.”
Good perspective added from one of the leaders of US lung screening studies.
The focus of the story was a comparison of lung CT versus x-rays or physician followup of patient symptoms.
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.”
The story put the new study in the context of other research in this field.
It’s clear the story didn’t simply rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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