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ASCO: Little Support for CT Screening

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http://www.medpagetoday.com/MeetingCove ... ng/tb/9713


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CHICAGO, June 5 -- Controversy and lack of evidence for a mortality benefit have made physicians reluctant to embrace spiral computed tomography (CT) screening for lung cancer.

Action Points


Explain to interested patients that CT screening is not currently accepted for wide-scale lung cancer screening.

Note that there is currently no good evidence to support a population-level mortality benefit from spiral CT lung cancer screening.

A session at the American Society of Clinical Oncology meeting was intended to debate the issue, but no one was willing to argue for lung cancer screening, said session chair Jacek Jassem, M.D., Ph.D., of the Medical University of Gdansk in Poland.

Spiral CT screening picks up 70% more lung cancers than X-ray imaging, said James R. Jett, M.D., Ph.D., a speaker at the session. Its lung cancer detection rate has been far better than sputum cytology overall as well in small studies, he said.

However, few oncologists are using the modality because "the issue has always been that there has never been a study that showed that it improves lung cancer mortality," commented Rebecca Heist, M.D., of Massachusetts General Hospital in Boston, in an interview.

Detection of early curable disease with CT screening in the International Early Lung Cancer Action Program (I-ELCAP) study caught everyone's eye, Dr. Jett said. Stage I tumors accounted for 85% of detected cancers in the study, with an estimated 10-year survival rate of 88% (See: Spiral CT Screening for Lung Cancer Detects Early Curable Disease).

The I-ELCAP investigators, led by Claudia I. Henschke, M.D., Ph.D., of Weill Cornell Medical Center in New York, speculated that screening could prevent some 80% of deaths from lung cancer in an at-risk population.

However, this still doesn't guarantee reduced mortality, Dr. Heist noted. The study included no control arm and simply "shows that it's a feasible process."

A more recent study showed that spiral CT diagnosed three times as many lung cancers as predicted and resulted in 10 times as many operations, but did not decrease mortality or advanced stage cancers.

That trial did not include a control arm either and could have missed a mortality reduction as large as 30%, Dr. Jett said (See: CT Screening Increases Lung Cancer Detection, but Mortality Is Unchanged).

"Until there's really clear data that there's a mortality benefit -- and that may be true, we just don't know that yet -- I think people are a little bit reluctant," Dr. Heist said.

Furthermore, detection is not benign, Dr. Jett said.

Surgical resection for screen-detected lesions was associated with a 27% complication rate and a 1.7% operative mortality rate in a Mayo Clinic screening trial, he noted.

A University of Pittsburgh trial, currently in press, showed that 34% of procedures ended in a non-cancer diagnosis.

Controversy also arose from the I-ELCAP study earlier this year when the New York Times revealed that the study had been funded with undisclosed tobacco company money (See: Lung Cancer Investigator 'Discloses' Funding of Tobacco Money).

However, this was probably less of a contributor to skepticism about CT screening than the lack of mortality data, Dr. Heist said.

"You always want to be very circumspect especially if tobacco has an interest in this, but I don't really feel like that's having a huge impact on how people are seeing things," she said.

"The concerns about lack of mortality benefit, the concerns about are we putting people with false positives through a lot of unnecessary testing … all of those concerns were voiced and well known before," Dr. Heist said. "It doesn't change the fact of what the studies show."

Whether there is a mortality benefit is being studied in large, controlled trials in both the United States and Europe. Results are expected by 2010 or 2011, Dr. Jett said. "Stay tuned."

Neither Dr. Jett nor Dr. Heist reported conflicts of interest. Dr. Jassem provided no information on conflicts of interest.

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(Medpage Today, By Crystal Phed, Staff Writer, and reviewed by Zalman S. Agus, Emeritus Professor, University of Pennsylvania, School of Medicine, June 5, 2008, Source: ASCO (American Society of Clinical Oncology Meeting)


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.

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What makes this ridiculous is the fact that they are relying on old, outdated survival rate statistics when they KNOW that survival rates have improved due to added therapies (chemos, targeted therapies, etc.).

It seems to me that, since their reasoning is faulty, it will probably continue to remain so, and that, as a result, they may end up deciding the mortality rate does not prove anything anyway as its improvement could be due to tx, not CT scanning and further slow down the implementation of CT screening.

In my own case (and I'm sure thousands of others), had CT screening been the norm--based on my being a heavy smoker--my tumor might have been found pre-lymph node metastasis, which most certainly would have increased my survival rate (Stage I instead of Stage III? I hope to shout!)

Oops! The latter sounds like a whine and since I am utterly dedicated to not crying over spilt milk, I'll just let out one of my infamous Arrrgggghhhs!!! and return to positive thinking (Yeah! I woke up again today and the roses smell great! :D)


Life is a Terminal Condition

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Bill's story includes a pulmonologist, who after assessing Bill with two digital Xrays, breathing tests, a history of smoking, a constant cough, and 22 years as a NYC firefighter, deemed him "OK." Nothing on the Xrays.

Took more months later to have a doctor in training at our GP's office push for a CT scan.

I know the trek - been there, done that. :x

Keep hope alive, and keep smelling those roses. 8)


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