Jump to content

NYTimes: To Scan or Not to Scan


Recommended Posts

http://www.nytimes.com/2008/04/24/opini ... ref=slogin


. . . . . . . . .

For as long as I can remember, a diagnosis of lung cancer has been virtually a death sentence. Most victims die within a year or two, and some 95 percent ultimately succumb to the disease. So it is hard not to be intrigued by a bold claim that most lung cancers could be cured through a screening program to detect tumors early and remove them promptly.

That claim has set off a bitter battle in scientific journals and forums that emerges occasionally into public view. Egos and personalities have clashed, derogatory comments have been muttered and conflict-of-interest charges have been flung at opposing scientists.

In one camp are researchers at Weill Cornell Medical College, who are convinced that screening asymptomatic smokers and former smokers with spiral CT scans — far more sensitive than conventional chest X-rays — could prevent some 80 percent of the 160,000 annual deaths from lung cancer in this country. That would be an astonishing feat, almost too good to believe.

In the other camp are distinguished experts in cancer and screening technologies who believe that the amazing claims will turn out to be greatly exaggerated, if not a complete mirage. They fear a repeat of a previous fiasco in which the medical profession latched onto chest X-rays as a way to detect and treat lung cancer early only to find out, when controlled studies were later performed, that the screening failed to reduce lung cancer mortality.

The core disagreement is over what to make of a large, multicenter study of spiral CT screening led by the Weill Cornell team. The researchers screened some 35,000 people with a history of smoking or occupational exposure. It was determined that 484 of them had lung cancer, and most of the tumors were surgically removed. They estimated that 92 percent of those who had early-stage tumors that were promptly removed would be alive 10 years later, a stunning survival rate compared with the roughly 10 percent who survive 10 years after diagnosis in current practice. All eight people with early-stage cancers who chose not to remove them died within five years.

That may sound like a slam-dunk case for spiral CT screening, but it isn’t. The researchers lacked a control group of people who did not get CT scans to compare with those who did. Thus they have no definitive proof that people who are screened die less frequently of lung cancer than those not screened.

This is not trivial. A contrasting study published last year underscored how misleading — and dangerous — it could be to assume that increasing the number of people who survive five or 10 years after diagnosis means that anyone’s life has been saved or lengthened.

The study analyzed the effects of CT screening in some 3,000 patients at three medical centers. Screening greatly increased the number of small tumors found and the number of surgeries to remove them, but it did not reduce the number of lung cancer deaths, which was the goal of the whole process. A plausible explanation is that a lot of the tumors would not have killed people even if left alone, while the truly lethal tumors were not caught in time.

Meanwhile, the screening itself led to follow-up scans, invasive biopsies and lung surgeries that caused sickness and death. That could be a huge problem in any large-scale program. In run-of-the-mill medical care in this country, lung cancer surgery kills 4 to 5 percent of patients and inflicts serious complications on many more. Those risks may not be worth taking if the benefit is small.

The best hope for an answer to the screening puzzle lies with a large federal trial of 50,000 current and former smokers that is comparing spiral CT screening with standard chest X-rays to see which saves more lives. The National Cancer Institute needs to do everything possible to expedite the researchers’ analysis of their data. The usual pokey pace of academic research seems inadequate when many thousands of lives could be at stake.

At this point, in the absence of firm evidence that CT screening is beneficial, no major medical organization recommends its widespread use. On an individual level, any heavy smoker who might want to get screened should recognize that there can be harms as well as benefits. The scans are so sensitive that they pick up lots of things not worth worrying about, yet once something is detected it is hard to resist the urge to do follow-up procedures. Any screening is best done by doctors sophisticated enough to recognize and treat only what really needs treatment.

. . . . . . . . .

(The New York Times, Editorial Observer, By Philip M. Boffey, April 24, 2008)


The information contained in these articles may or may not be in agreement with my own opinions. They are not posted as medical advice of any kind.

Link to comment
Share on other sites

I notice that the article says:

The best hope for an answer to the screening puzzle lies with a large federal trial of 50,000 current and former smokers that is comparing spiral CT screening with standard chest X-rays to see which saves more lives.

BUT routine chest x-rays are no longer recommended. I am one of the lucky few whose internist still does them, so my cancer was picked up early.

I think they need a third group who are left to flounder until they develop symptoms.


Link to comment
Share on other sites

Unfortunately, my husband's very late diagnosis happened due to a lack of a CT scan.

He had two digital X rays taken by his pulmonologist (at the time), and they came up clean - absolutely no sign of cancer.

He has now progressed to a stage IV due to not having a CT scan at the time he was coughing, had a history of smoking, and had been a firefighter for 22 years - in fires that had asbestos in their mix.

X-rays do not always tell the tale - not with every individual. They are not reliable. Cancer can "hide" behind organic structures and not be "seen."

The CT scan is the ONLY reason Bill is still with our family.

God bless the GP and his going for the CT scan. We can enjoy Bill being with us due to that decision.


Link to comment
Share on other sites


I agree with you entirely. I sure think CAT scans are in order, especially for smokers or ex-smokers.

My point was that most doctors don't even do routine chest x-rays anymore. I am an ex-smoker whose father died of lung cancer, yet most of my friends (doctors and others) were very surprised when they learned that I had had an x-ray as part of my annual physical.

After my diagnosis, my sister went to her doctor and said that her father had died of lung caancer and her sister had just been diagnosed, so could she please have a chest x-ray. He immediately ordered a CAT scan -- fortunately negative.

I didn't mean to imply that chest xrays were better than CAT scans, I just wanted to point out that no one is even doing screening chest xrays anymore.

I'm glad you found a doctor who ordered a CAT scan and that Bill is still with you! Cough, fire-fighter, ex-smoker -- seems like a no-brainer. But what do I know, I'm just a patient not a doctor. :?


Link to comment
Share on other sites

Yes, Linda, I agree with you entirely. I surely think CAT scans are in order for smokers and ex-smokers, if they should seek one.

I know that they have pretty much stopped doing routine x-rays. Years ago, that was expected as part of the yearly exam. I used to get them.

It is wonderful that an x-ray caught you early. What a blessing.

Thank you for responding to the article, Linda. I appreciate your input very much.

Would you believe that even to this day, my heart breaks when I think of that original non-diagnosis?

I guess it will never fade in our memory.

We are living with the result.


Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Reply to this topic...

×   Pasted as rich text.   Restore formatting

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

  • Create New...

Important Information

By using this site, you agree to our Terms of Use.