The story promotes lung cancer CT-screening for smokers or former smokers as a means of early detection of non-symptomatic, curable lung cancer. The story discusses the cost of these specialized CT scans (several thousand dollars), and mentions that health insurance and Medicare are not likely to cover this screening, thereby making it unavailable for many people. The story does not mention what is involved in subsequent screening and treatment (i.e. biopsy or surgery) if there is a suspicion of lung cancer. Additionally, any nodules and other abnormalities that are detected and followed-up with annual CT scans may not come to biopsy, but may carry cost and inconvenience, if not morbidity. The story does not mention other strategies for early detection, such as plain x-ray films.
The story engages in "risk mongering." This test is certainly not right for everyone– not even for all smokers or former smokers– and a clean scan does not necessarily mean you are lung cancer free. The abscence of a nodule on the scan does not in any way indicate a patient's health is "completely fine," as the doctor in this news report states, because years of smoking usually produces lung and other problems, often compromising health and shortening life.
The story cites additional sources, including an oncologist who warns against mass screening, especially if you are not a person at high risk of developing lung cancer. However, the manner in which the story is presented is not objective health journalism. Positioned at the end of the piece, the journalist’s "cancer-free" report trumps earlier caveats from a cancer specialist, including the warning about the lack of specificity of this test for detecting early stage lung cancer.
We should remain wary about a news story presented by a network that is part of the company (GE) that makes CT scanners, and that also helped to fund the study about which the reporters are conveying information.
The story discusses the cost of CT scans for lung cancer (several thousand dollars) and mentions that health insurance and Medicare are not likely to cover this screening.
Additionally, there are costs of diagnostic and therapeutic procedures that result from this screening that ought to be considered.
The story provides no quantification of benefits. We are given anecdotal evidence in the form of an enthusiastic review by an NBC journalist who was deemed "cancer free" after having a CT scan. The abscence of a nodule on the scan does not in any way the patient's health is "completely fine," as the doctor in this news report states, because years of smoking usually produces lung and other problems, often compromising health and shortening life.
The story does not mention the harms of this screening, which include: false positives, which may result in unnecessary lung biopsies (which carry their own risks) and unnecessary anxiety and distress, exposure to radiation greater than an x-ray, and the risk of a false negative result which may prevent a patient from seeking treatment, or provide a false sense of confidence to continue smoking behavior.
Additionally, any nodules and other abnormalities that are detected and followed-up with annual CT scans may not come to biopsy, but may carry cost and inconvenience, if not morbidity.
In the recent New England Journal of Medicine study, 43 biopsies were performed that did not yield a diagnosis of any type of cancer, or approximately 9% of biopsies. Whether this is an importantly high rate depends on the morbidity of the procedure, which is not discussed. And the abscence of a nodule on the scan does not in any way imply the patient's health is "completely fine," as the doctor in this news report states, because years of smoking usually produces lung and other problems, often compromising health and shortening life. In the source study, indeed, a handful of cancers were detected not by scans, but because subjects developed symptoms and came to evaluation.
The story presents no evidence that lung cancer screening increases survival due to early detection and treatment. Instead, what may occur is a "lead-time bias" by which early detection may only appear to improve lung cancer mortality, but in reality the earlier detection only starts the clock ticking earlier in the disease process, not affecting outcome significantly.
The story provides no context or reference for the figure that "80% of lung cancer death could be prevented by early CT screening". We are not told how specific this test is for detecting lung cancer, nor does the story mention the rate of false positives or false negatives. In the study recently published in the New England Journal of Medicine, the rate of true "positive" scans was 479 cancers diagnosed out of about 59,000 scans performed, well under one percent of scans in patients with some industrial or tobacco smoke exposure. As the story notes, there have been no studies comparing this test with a control group who did not have the scan.
The story engages in "risk" mongering, based largely on the reporter stating his intention to continue on an annual screening basis himself, implicitly supporting the claim of efficacy in this screening. This test is certainly not right for everyone–even if they are a smoker or former smoker– and a clean scan does not necessarily mean you are lung cancer free. The test has not been shown to prevent death from lung cancer, as early detection does not guarantee a cure and we don't know what happens over the long term to those whose scans don't show an abnormality.
The story cites additional sources, including an oncologist who warns against mass screening of smokers. While sources are interviewed for perspective on the screening, the way in which the information is presented is biased: The journalist's personal experience of the scan appears to trump any caveats by a cancer specialist, including his concern about the lack of specificity of the scan for detecting lung cancer.
We should remain wary about a news story presented by a network that is part of the company (GE) that makes CT scanners, and that also helped to fund the study about which the reporters are conveying information.
The story does not mention what is involved in subsequent screening and treatment (i.e. biopsy, surgery and/or chemotherapy) if there is a suspicion of lung cancer. The story does not mention other strategies for early detection, such as plain x-ray films. The story also does briefly mention quitting smoking, a lifestyle change proven to reduce death by lung cancer.
The story does not mention where this specialized CT screening is available. We are told that health insurance may not cover this screening, therefore, it would be cost-prohibitive for many people.
Screening otherwise healthy smokers or former smokers via CT scans is a new approach to detecting early lung cancers. We do not yet know how well the early screening works in preventing deaths due to lung cancer.
The story does not appear to rely on a press release. There is independent reporting.
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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