The Downside of a Cancer Study Extolling CT Scans Tara Parker-Pope NYT – November 15,

Prime Time? Are lung cancer scans really ready for prime time? News that annual CT lung scans can reduce the risk of lung cancer death among former and current heavy smokers was celebrated by national heath officials this month. A major government study found the screening scans saved the life of one person for every 300 current or former smokers who were scanned.CT lung scans can reduce the risk of lung cancer death But now cancer and screening experts are worried that the limited findings will be used by private screening centers to promote the test to a broader group than was studied. That, in turn, could lead to thousands of unnecessary lung scans, causing excess radiation exposure and unnecessary biopsies and surgery.

National Lung Screening Trial The study, called the National Lung Screening Trial, focused on 53,000 current and former heavy smokers, aged 55 to 74, who had smoked for at least 30 pack- years. That means someone who smoked 1 pack a day for 30 years, 2 packs a day for 15 years or 3 packs a day for at least 10 years would qualify for the study.National Lung Screening Trial Former smokers who had accumulated 30 pack-years were included only if they had stopped smoking within the previous 15 years.smoking The smokers and former smokers were given either annual CT lung scans or chest X-rays. Compared with conventional X-rays, the CT, or computed tomography, scans create a detailed three-dimensional image of the lungs. The study was stopped when it was found that the scanning group had a 20 percent lower risk of dying from lung cancer than those being screened with X-rays.

Downside of scanning But the early results also showed a downside of scanning: one of every four lung scans showed an abnormality, which often led to additional worry, radiation exposure from follow-up scans and, sometimes, lung biopsies and even risky surgery. But because the study was stopped early, a full analysis of the harms caused by screening scans is still months away. Reading the scans is tricky because harmless nodules can be misinterpreted as suspect lesions. In the study, even experienced radiologists at major cancer centers had a high rate of false positives, suggesting that the rate would be even higher in the real world.

Economics – Response 1 1. Let me make this personal for you. I participated in the ELCAP lung cancer screening program in 2005, 2006 and my last scan was May This was a huge international study. I joined because I was a scared long term smoker. I paid $300 for each low rad CT in the study. In late 2007 or 2008 I received a letter stating the study was being terminated as it had been determined it cost too much to save a life (they said it nicer). A month ago I was diagnosed with inoperable small cell lung cancer. I am 57 years old. I should have continued the scanning on my own. My doctor thought I was a ninny to join the study. He was wrong. — Pam

Economics – Response 2 A few years ago, an X-ray and follow-up CT revealed a suspicious nodule in my lung. I had no symptoms and was never a heavy smoker. Although the pulmonologist, surgeon, and my husband, an MD, all counseled surgery, I refused. I finally found a doc at Sloan Kettering who recommended I get another CT scan in 2 months. The nodule did not change. Within 18 months, I had 2 more CT scans. The final diagnosis: they have no idea what’s in my lung. But I avoided the invasive biopsy (really, it’s surgery) and have gone about my life. I fear that like me, many people who undergo these screening CTs will have false positives. It’s difficult to argue with those who say “it’s worth it If we only save one life” but that’s why health care costs are out of control. — Nancy A.