To have and have not: A better way to screen for lung cancer

Our Review Summary

This story reports on the results of a study on using CT scans to screen for lung cancer screening published in the New England Journal of Medicine. This study appears to indicate that all people at "high risk" (current or former smokers) could benefit from screening. But unfortunately, because of the limitations of this study, the question of whether screening for lung cancer saves lives remains to be answered. This story grossly exaggerates the strength of the existing evidence by promoting CT screening as a "shining light" to "cure" lung cancer. Citing questionable statistics and lacking in balance, this story does a disservice to its readers.

Although the story does describe the design of the screening trial, it minimizes the limitations of the available evidence. The story seems to treat the lack of a control group as a minor issue and downplays the potential for bias in the design of the study. The story also does not mention other studies that have failed to show a mortality benefit from lung cancer screening with X-rays.

The story minimizes the potential harms of screening. The story describes the radiation exposure from CT as being equivalent to that of a mammogram. It is not clear where this information comes from. CT scans generally have many times the amount of radiation exposure of x-rays.

While the story provides some quantification of benefits from screening, it also exaggerates these benefits in qualitative terms. The story claims that the study is a "shining light" and that screening could "cure or substantially lengthen the lives" of lung cancer patients. Unfortunately, the current study does not prove that screening actually lengthens lives. 

By accurately describing the seriousness and prevalence of lung cancer, the story avoids disease mongering. However, the story verges on "treatment mongering" by comparing lung cancer screening to the "many cures" from prostate cancer screening, which has not been shown to save lives. Furthermore, the story inappropriately highlights a patient with a cough, a symptom of lung cancer, who went on to die of the disease. First, it is not clear if doing the CT scan in this patient would have prolonged his life and second, this example highlights the use of CT for diagnosing lung cancer, not screening for lung cancer in people who do not have symptoms. These are very different concepts.

The story does not mention the cost of the scan, an important piece of information for the consumer given that insurance is unlikely to cover it. Finally, the story only quotes the lead author of the recent study, Claudia Henschke. The story should have quoted other clinicians or researchers who could have provided some much needed balance.